Wiki Modifiers - apparently I a clueless

[dittotee]

I have six claims that I thought I knew I was doing but apparently I do not. I would love some help!!!!! (There will be a common thread with all six . . . .).
1st: 99204 and 76881 (Is there a modifier needed, like 25 and if so which code does it attach too?)
2nd: 99204, 97110 & 76881 (Same as above but would I add an additional modifier of 59 to 97110?)
3rd: 99204, 20606 J3301, J2001, 97110 (Same as the other two above and or does 20606 get a modifier?)
4th: 99204, 76881 and 29540 (You get the gest . . . )
5th: 99215 and 64455 (Modifier 59? and too which one?)
6th: 99215 and 11730 (See above?)

 

[Henson65]

The 25 modifier always goes on the E/M only, this is when an evaluation and management is performed with another procedure.
CPT 20606, 29540, 64455 requires a laterality/location modifier

Hope this helps....

 

[gpatrickrn]

I have six claims that I thought I knew I was doing but apparently I do not. I would love some help!!!!! (There will be a common thread with all six . . . .).
1st: 99204 and 76881 (Is there a modifier needed, like 25 and if so which code does it attach too?)
2nd: 99204, 97110 & 76881 (Same as above but would I add an additional modifier of 59 to 97110?)
3rd: 99204, 20606 J3301, J2001, 97110 (Same as the other two above and or does 20606 get a modifier?)
4th: 99204, 76881 and 29540 (You get the gest . . . )
5th: 99215 and 64455 (Modifier 59? and too which one?)
6th: 99215 and 11730 (See above?)

For the 1st one: check if the E/M service warrants the use of modifier 25. The E/M service should be considered as significant and separately identifiable from the procedure being provided.
For the 2nd one: you may want to check if CPT 97110 and 76881 has a bundling edit per NCCI/McKessen. Usually the imaging guidance is a component of the procedure. After checking note which is the column 1 and column 2 procedure. You will append mod 59 to the column 2 code to indicate that the procedure is considered as separate to the column 1.
For the 3rd, 4th and 5th, you may want to append a laterality modifier (LT or RT) depending on which side the procedure was done.
For the 6th, I feel that a modifier 25 would do. Again if it is supported.

You may also want to check out the Sep 2018 webinar regarding the modifiers. It is under the Quarterly Free Webinar in AAPC.
https://aapcstream.s3.amazonaws.com...y-Used-Modifiers-in-the-Physicians-Office.mp4

Hope this helps.

Patrick

 

[mitchellde]

Also you do not bill the J2001 code that is a code for IV lidocaine. Lidocaine administered with an injection is inclusive and not billable. Also watch billing 97110 with an E&M on the same day with the same provider typically payers will consider the 97110 and deny the E&M.