Reader Question:
Using a Modifier with 99204
Published on Sat Jan 01, 2000
Question: A new patient comes in for diagnostic code 626.2 (excessive or frequent menstruation), CPT 99204 (new patient visit; comprehensive history and examination, moderate-complexity medical decision-making), plus 622.7 (mucous polyp of cervix), 58558 (hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C.) [formerly 56351]. Do we use a modifier on the 99204?
Barbara Detwiler
Jefferson Healthcare
Collegeville, Pa.
Answer: Yes, you have to use modifier -25 on the office visit (99204). Even though there is a different diagnosis (622.7), most carriers computers screen for the appropriate modifier before reviewing the diagnostic code. The claim will be kicked out at the first sign of error.