Billing a 99203 on same day as a surgery done at an ASC facility, outpatient

mcarrillo

Networker
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47
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0
Hi,

I have a doctor who saw a new patient for CC of left foot pain, and there was a punture wound. A piece of mesquite thorn was in the wound. The doctor assesed the patient and examined him and then decided to remove the thorn. The patient and him agreed to do it at a surgical center, outpatient. He scheduled him and performed the removal the same day. Doctor is billing for a 99203 for the office. And then turned in charges for the foreign body removal at the ASC.

Is this okay to bill, or does the decision for surgery from office on same day apply? I can only find information on how it would be included if the patient was admitted to the hospital as in inpatient from the office visit.
Please help

Thanks :)
 

boo2unme

New
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You would bill the 99203 with a modifier 57, not 25, if the procedure was performed outside the office.
 

mcarrillo

Networker
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Thank you both for your quick responses.
I will add the 57 modifier, the procedure has a 90 day global.
:)
 

withem

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E&M with mod and laceration repair

We have a walk in facility along with our Family Practice. Same building same tax ID. A patient came in with a deep laceration. In deciding of we could suture in our office vs sending to the ER or a specialist required a consultation with one of my physicians and reviewing x-rays. I have billed an E&M with a 25 modifyer and the laceration repair code. An insurers code audit company is telling me they want the money paid for the OV back. In cases like this, where it is emergent care I do charge the OV as we don't decide to perform surgery without this evaluation. They will not accept any modifyer. We do post surgical care at no charge per the global window. Am I wrong here?
 

losborn

Guru
Messages
125
Location
White Plains, NY
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Hi,

I have a doctor who saw a new patient for CC of left foot pain, and there was a punture wound. A piece of mesquite thorn was in the wound. The doctor assesed the patient and examined him and then decided to remove the thorn. The patient and him agreed to do it at a surgical center, outpatient. He scheduled him and performed the removal the same day. Doctor is billing for a 99203 for the office. And then turned in charges for the foreign body removal at the ASC.


So what is the medical necessity for moving this to the ASC?

Lin
 
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