Carenom1
Guest
Can we bill an E/M code (99214) with 11042 and 93922? If so what modifiers do we use. Do i use 25 for E/M, 59 for 11042, and 52 for 93922 or RT/LT?
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Wiki 93922
- Thread starter Carenom1
- Start date
Carenom1
Guest
Anyone able to respond to my questions. Need the assistance.
Can we bill an E/M code (99214) with 11042 and 93922? If so what modifiers do we use. Do i use 25 for E/M, 59 for 11042, and 52 for 93922 or RT/LT?
Can we bill an E/M code (99214) with 11042 and 93922? If so what modifiers do we use. Do i use 25 for E/M, 59 for 11042, and 52 for 93922 or RT/LT?
lgardner
Guest
I just checked the edits and it looks like the only conflict is between the 99214 and the 11042.
I would submit:
99214 -25
11042
93922
I would submit:
99214 -25
11042
93922
Carenom1
Guest
Thank you. So I do not need to add a modifier to 93922. When billing 93922 with the other two codes or with 11042 claim denys.
amyjph
True Blue
This is something you can look up using CPT descriptions, NCCI edits/manual and Appendix A-Modifiers. There are also resources such as payer guidelines, CMS MACs, LCD, NCD etc.
Just because you can add a modifier doesn't mean it should be appended if there is no documentation to support it.
www.novitas-solutions.com
Just because you can add a modifier doesn't mean it should be appended if there is no documentation to support it.
Modifier 25 fact sheet
www.novitas-solutions.com
lgardner
Guest
agreed. these decisions are ALWAYS based on the documentation and medical necessity.
Carenom1
Guest
Thank you for all the information. since I am studying to be a new coder what can we use to look to see if a CPT requires a modifier? I see in the CPT manual that 93922 when billing 2 arm or leg then will bill with 52 modifier. So is this how it should look on the claim 99214-25,11042,11045-59,93922-52? Please advise.
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