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2 E/Ms, one with mod 25

HCCCoder

Guru
Messages
121
Location
Woodland Hills, CA
Best answers
0
Hello all,

Pediatrician has a nutritionist on site. Pt was seen by the pediatrician and the nutritionist on the same DOS.

Can they bill 99244 and 99212-25 on the same claim?

I don't think so, just want to hear other opinions.

Would someone be able to explain in different ways or to support this with a web site or any documentation ?

Any help and ideas would be greatly appreciated.

Thanks,
Lilit
 
Messages
222
Best answers
0
Hi,
Nutrition counseling is included in the CPT codes for preventive medicine services-
If nutrition aspects dealt in a separate encounter, may be CPT code like 99402 tried-
 

lphillips

Guru
Messages
108
Location
Anchorage, AK
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0
what are the diagnoses?

Looks like you are billing and Consult and office charge - would need more information - was the patient seen for seperate reasons?

Sometimes billing 2 office charges is correct - depending on the circumstances and diagnosis.
 

kevbshields

Guest
Messages
1,101
Location
Louisville, KY
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0
Nutritionists/Dieticians cannot use E/M codes. They have their own service codes available in the Medicine Section of CPT. I cannot determine a reason you'd bill a consult for the services of a nutritionist.

Good luck with solving this. I'd think that the correct code combination would be ok on the same claim.
 

mholland

Networker
Messages
35
Location
Joshua Tree, CA
Best answers
0
2 e/m 's same day

Yes they can both be billed together - you have to make sure there is a condition code GO on the claim and the first e/m reguires a 25 modifier the second e/m would have to have 25, 27 in order for both services to be reimbursed.

Mholland CPC
 

SCanterbury

Networker
Messages
74
Location
Saint Marys, GA
Best answers
0
As Kevin pointed out, nutritionists can not use E/M codes. These codes represent physician services. A few specific types of non-physician practitioners, like PAs and ARNPs, who by the nature of their credential are allowed to provide services usually described as "physician" services, can also bill these, but this provision does not apply to nutritionists.

Seth Canterbury, CPC, ACS-EM
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
Both Seth and Kevin are correct. Nutritionist do not use the E&M codes for their services, and the codes from the medicine secion are bundled with the E&M codes and for that reason the nutritionist visit is usually considered incidental and a part of the physician encounter. Depending on the documentation and the stated reason for the encounter you might could use the 98960 code for education and training for patient self management, which is not bundled with the office visit but carries only .66 RVUs.
To address the response by mholland; Only a facility may bill two visit levels on the same day using the 27 modifier and the G0 condition code, this is not allowed for physician billing.
Debra Mitchell, MSPH, CPC-H
 
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