Wiki 99183 and 99223

[kerinnejb@icloud.com]

Need help please
In the inpatient setting a patient was evaluated and H&P done by MD. Patient meets the criteria for HBO and HBO was performed the same day by same MD. According to CPT description E&M (eg. CPT 99223) can be billed in addition to the HBO (CPT 99183) because they are separate procedures.
Can the provider bill the 99223 along with 99183 using modifier 59 on the CPT 99183 and 99223 without a modifier 25. Note please the diagnosis is the same for the CPT 99223 and 99183 59.

Appreciate your help

Thank you
Judith

 

[lgardner]

In order to be able to bill an E/M, there would have to be documentation showing that there was a "significantly and separately identifiable E/M service".
What you are describing sounds like it would be included in the 99183.
(EDITED to add - I cannot give you a definitive answer without seeing the documentation)

per CMS:

• Preoperative visits after the decision is made to operate, beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures. NOTE: The initial evaluation for minor surgical procedures is always included in the global surgical package.

here is another useful tidbit:
Minor Procedure: A procedure with a 000 or 010 day Global Period

•E&M services on the same date of service as a minor surgical procedure are included in payment for the procedure and considered part of the work of the procedure.
•The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E/M service.

 

[thomas7331]

CPT 99183 is not a surgical procedure and does not have a global period, so the surgical package rules don't apply here and would also likely make modifier 59 incorrect. However, the NCCI policy manual gives the following guidance in chapter XI, section T.4, so if your documentation for the visits meets the requirements given here, you can bill a modifier 25 on 99223:

Physician attendance and supervision of hyperbaric oxygen therapy (CPT code 99183) includes E&M services related to the hyperbaric oxygen therapy. E&M services integral to this procedure include, but are not limited to, updating history and physical, examining the patient, reviewing laboratory results and vital signs with special attention to pulmonary function, blood pressure, and blood sugar levels, clearing patient for procedure, monitoring and/or assisting with patient positioning, evaluating and treating the patient for barotrauma and other complications, prescribing appropriate medications, etc. A provider/supplier shall not report an E&M CPT code for these services. If a physician performs unrelated, significant, and separately identifiable E&M services on the same date of service, the provider/supplier may report those E&M services with modifier 25.

 

[kerinnejb@icloud.com]

Thanks for the feedback