Medical Billing Blog with Medical Billing & Coding Info & Articles
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Welcome to the medical billing blog containing news and articles relating to medical billing, medical coding, ICD, HIPAA and practice management functions.
2004-2024 Celebrating 20 Years of Healthcare RCM Articles
The Blog Currently Contains 1,265+ Healthcare Articles
Using Modifier 25 in Medical Billing
When claims require modifier 25, there are some simple tips you can use to know the modifier’s details, such as which code to append it to, as well as when to use the modifier. It is important to identify the claim makeup in order to solve the problem of which code to use modifier 25 with. Modifier 25 is a significant, separately identifiable evaluation and management service by the same physician on the same day as the procedure or other service. Do you attach modifier 25 to the well visit or to the sick code? Modifier 25 can be applicable on either code. Therefore, the answer depends on the claim …
Team Procedures
All too often, the problem in the case of team procedures, where multiple physicians are involved, is that the first physician’s claim that gets submitted wins. This is especially true when another provider takes credit for radiology services. Let’s take a look at a few examples, to help you figure out how to code your claims to make sure you get a radiology claim to your payer quickly. Example 1: Do both a radiologist and a speech language pathologist need to be present to code a modified barium swallow procedure? They may both need to be present. Guidelines recommend that the service be provided in a team setting. Note the …
Multiple Angiographies
It can sometimes be perplexing when a physician performs angiography on both legs and one arm. Which CPT codes should you use when reporting these procedures? You should report 75710 (which is Angiography, extremity, unilateral, radiological supervision and interpretation) as well as 75716 (angiography, extremity, bilateral radiological supervision and interpretation). Append modifier 59 (which is distinct procedural service) to code 75710. This will show that the procedures were in fact performed on different areas (the arm using the unilateral code and the legs using the bilateral code). The reason for this is that the National Correct Coding Initiative edits bundle unilateral angiogram code 75710 into bilateral angiogram code 75716 with …
E/M and Repair on Laceration Claims
Let’s say an otherwise healthy man reports to the ED with lacerated index and middle fingers on the palmar surface, but there is no significant bleeding. The patient cut himself on a table saw. There is a 1.5cm jagged laceration with protruding fat located on the pad of the distal phalanx of both fingers. The physician uses Marcaine to apply digital blocks to both fingers, explores the wounds and finds no foreign bodies, and then closes the wounds. This encounter should be coded with a pair of E codes, in order to identify the cause of injury. Report this claim as follows: Report 12002 for the wound closure (this is …
Why it is Necessary to Demonstrate Medical Necessity
Some physicians and coders believe that CPT guidelines allow for reporting 99215 for any established patient based on a comprehensive history and examination, even if the MDM is low risk. By this reasoning, you may report 99215 for any E/M visit where the physician documents a comprehensive physical and exam, even if he or she only treats a minor problem. However, this is a myth. CPT E/M guidelines do not offer a legal loophole allowing them to ignore medical necessity. The nature of the problem for which the patient presents is the measure of medical necessity for E/M services. This is included for every level of service. If medical necessity …
