• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
  • Important Note: We will be performing a scheduled maintenance on 1st November 2020. The site will be offline from 7:30PM (MT) till midnight. We apologize for any inconvenience this may cause.

Correct Coding for 99203 within 3 years

Messages
1
Best answers
0
I work for an orthopedic group and per Medicare guidelines we can charge a new patient visit within the three year period if the patient sees another physician because sports medicine is now its own specialty. The patient is seeing another doctor in the group. It was originally coded at 99203 with a 24 modifier. Medicare rejected as modifier inconsistent with procedure code. I thought this would be incorrect in the first place as the description states that the 24 modifier is a separate e/m service within the post operative period by the SAME physician. The patient is actually seeing a different physician for a different problem not related to the surgery. However she is within the global period on a surgery by the first orthopedic doctor. Can someone help me with the correct coding for this scenario?
 
Messages
154
Best answers
0
I think there is no need to append modifier 24, because you are coding it as a new patient as sports medicine is own speciality and more over The patient is actually seeing a different physician for a different problem not related to the surgery which was performed previously. If the patient has went to another physician who is in the same speciality under same group then you can code it as new patient. I guess here you should code it as established patient if the physician is under the different group ID.
 
Last edited:

jbrightw

Networker
Messages
92
Best answers
0
Modifier 24 states 'Unrelated E/M service by the same physician during a postoperative period'. But here the patient is seeing a differant physician and you have assigned 99203 as new patient. Till here you are correct.

Modifier 24 always to be assigned with established visits, because when a patient come to the same physician during a global period, it must be an established visit (9921X).

For new patients please dont use 24 modiifer. Am I right?

Brightwin
 

zoolug

Networker
Messages
26
Location
Hartford
Best answers
0
24 should be on an established code

I agree with Brightwin. 24 does not make sense with a new patient code, which seems to be what medicare is saying. I think you can code it with 99203 and no modifier. I can't swear Medicare will recognize that the specialty is different and pay it, but that seems like the right way to code it.
 

dclark7

True Blue
Messages
723
Location
Hartford, CT
Best answers
0
You should not need a modifier for this visit. However you do need to make sure that the physician's specialty with Medicare is listed as sports medicine. Physicians self designate their specialty in PECOS, so even though the specialty is recognized, if the physician is not credentialed under that specialty code (23 for Sports Medicine, 20 for Orthopedics) Medicare will not recognize him as a different specialty.
 
Top