Wiki 99213,25 +76830

[kerileigh]

If the MD schedules the patient to come back for an USG and after the USG is done he then sees the patient to tell them the results and next step in care can he charge an e/m with that USG?

 

[ecrean]

yes u can

 

[N70QW]

Ultrasound bundling

I am new to ultrasound billing and coding and would like to understand the logic behind needing a modifier 25 on the office call. I billed a 99213 along with 76856 TC and did not use modifier 25 on the office call but received a denial stating the 76856 TC ultrasound was bundled with the 99213 according to the CCI edits. I can and will add the modifier 25 but I don't understand why it needs it. Can someone enlighten me?

 

[thomas7331]

There's a good explanation of the reasoning for this in the NCCI manual in Chapter IX on Radiology Services which you can find on the CMS web site. It's too much to copy here but it says basically that certain radiology services do normally involve pre-, intra- and post-procedural physician work that may include obtaining some history or MDM, and that this should not be reported as E&M unless it is significant and separately identifiable, in which case the modifier is appropriate.