office coding


Albany, KY
Best answers
I have recently started working at a local doctors office. I am employed at the local hospital as an IP/OP coder. This local doctors office having a hard time with their billing and lack of money. I need to know how everyone else codes this example: Patient comes into the office and is seen by the doctor, 99213, receives a Rocephin injection and a CBC is obtained. This patient has Medicare. I coded this as 99213-25, 90772, Jcode for Rocephin and the CPT code for CBC (those I can not remember off the top of my head).

Is this the correct way to bill this visit?
Medicare will not pay for both the office visit and the administration even though it was modified. The admin is rolled into the office visit and no modifier would need to be used.
That may be a LCD. The ov and the adm are not bundled where we are. We are an oncology practice and routinely bill for ov's and adm on the same day.
It's true that Medicare may not pay for both the 90772 and 99213, but you are coding it correctly as long as you have distinctly different diagnosis codes for each service, or there was significant workup involved in determining to administer the drug. This, of course, is the standard rhetoric for modifier 25 - but you were asking if you were coding correctly. I would say yes, as long as the conditions above were met.
I work for a rural family practice and in our state medicare will pay for a 99213-25, 90772 and roceph. charge. good luck:)