Wiki Help Please!!!

[msbrowning]

Ok, here's the thing. I am coding a chart and according to the Clean Claim Connection, I can only bill the E/M because x-rays, lab tests, EKG's etc, are not separately reimbursable. Is this correct or do I need to code the separate procedures and add modifier 26 to the x-rays and 51 for the multiple procedures, such as a x-ray, strep test done on the same ER visit? This is a critical care chart (99293) and the Clean Claim Connection is telling me that all I can bill for is the 99293, but in addition to the 99293 I have 71010, 99090, 85025, 80048, 81000 and 84484.

 

[jason.mangum]

response to help needed

The x-rays and labs are included in the CC E&M code. The EKG can be coded separately but if you look in the critical care coding guidance in the CPT book prior to the CC code listings then you will see that x-rays and labs are an inherent part of the E&M. As for the EKG it should be billable as long as the physician was present at the time of the test and then personally interpreted the results and recorded the results in the patient's chart.

Hope this helps.

As for any labs, unless that physician is actually performing the tests or examining specimens and preparing a report, then they cannot be coded by that physician.

 

[jimbo1231]

Need more info

Are you doing physician or facility coding? If physician,that chart isn't codeable as is. We would have to look at HPI/ROS/PE to determine Level. Having said that if the documentation were there it looks to be higher then a 99283 depending on documentation. Jim

 

[LTibbetts]

modifiers

Always look at the -25 modifier first before the -51 for ER coding. For any infusions, CT's, etc. done in the ER, I attach the -25 modifier to the E/M codes and it always gets paid.