Wiki billing for a neurologist - I hope someone can answer my questions

[apena]

Hello,

I hope someone can answer my questions. I just started working for an neurologist and getting to know their billing.

While reviewing a claim that was denied they billed the claim with 99213,95921-59,95922-59 and 93040-59.

Apparently, the 99213 cpt code was billed on a different claim and never arrive at the insurance company.

My question is: will all of this cpt codes 95921, 95922, and 93040 require the modifier 59.

To my understanding they have always billed them with the modifier 59 and never had a problem until this year, which they are now being denied.

Can someone please help me.

Thanks.

 

[Emmy1260]

There is a new code for 2013 - 95924 Combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt. There is a notation following 95922 to not report 95922 in conjuntion with 95921.

When an E/M is billed for the same date of service as a procedure, we add a -25 modifier to the E/M code.

As for the -59, I think -51 should be used, but modifiers are not my strongest point.

 

[jojo419]

Do you have any reference tools like Supercoder.com or Find-A-Code.com? They do CCI edits with rationales and tell you what modifiers work best.
If you are week in the understanding of modifiers, you should visit www.codingcertification.org/joannesheehan (I am a great advocate of coding certification tools)and Laureen Jandroep has an excellent quick training on modifiers and a template that will assist you in understanding.
There are also programs to bring you up to date for the many changes in 2013 coding. Check out www.aapc.com too.
As coders, we need to have as many resources at our fingertips as possible to be the best that we can be. I often wonder how I managed before the age of computers and Internet!

 

[airart]

Resources

Here is another resource for you for Neurology billing. Its a PDF slide show from the AMA on changes to Neurology coding for 2013.

http://www.ama-assn.org/resources/doc/cpt/05-neurology-barkley.pdf

Save, Print, and Study.

For all other specialties and interesting info here is the link for your specialty changes for 2013 for you to download, including one for common issues.

http://www.ama-assn.org/ama/pub/phy...illing-insurance/cpt/cpt-rbrvs-symposium.page

Scroll to bottom of page under; "Presentation slides from Symposium topics"

•Moving CPT into the future
•AMA Specialty Society RVS Update Committee (RUC)
•Medicare Physician Fee Schedule Payment
•E/M – Focus on CPT Changes
•Neurology
•Qualified Health Care Professional – Terminology Revisions
•Cardiothoracic Surgery
•Psychotherapy
•Pathology
•Cardiology
•Gastroenterology
•Ophthalmology
•Radiology
•Interventional Radiology/Vascular Surgery
•Pulmonary/Sleep Medicine
•Allergy
•Contractor Medical Directors – Common Coding/Claims Issues and Q&A
Presentation slides from Symposium topics