office visit and preop consult

heathergirl

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Can these be billed together? (99213, and 99242) And if so, the n what modifier would I use? Thanks


Heather D Unklesbay, CPC, MA
Office Manager
 

jennifer.cooper

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modifier 25

Yes they can be billed together however you have to have a significant and separate reason to charge for the office visit. You wouldn't want to have a compliance issue if it wasn't right to charge for both. This will possibly be flagged by insurance company, too.

To answer your question you would append the modifier -25 on the office visit.
 

rthames052006

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Can these be billed together? (99213, and 99242) And if so, the n what modifier would I use? Thanks


Heather D Unklesbay, CPC, MA
Office Manager
What is the scenerio that your billing both 99213 and 99242. Can you elaborate a little bit more on this.
 

heathergirl

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Explanation

The Patient is a 77 year old female who presents with Chief Complaint preop clearance: no trouble with meds other than amoxil, fosamax and actonel (gerd). No problems with anesthesia to her knowledge, no bleeding issues. She takes advil prn for knee pain. Advised to hold that for a week before surgery, okay for tylenol if need.; follow-up on GERD for which our most current records show that the patient is currently taking Prilosec: Status From Last Visit resolved since stopping the actonel.; follow-up on Osteoporosis unspecified for which our most current records show that the patient is currently taking actonel, caltrate: she stopped the actonel due to GERD and that has resolved. She is concerned about her bone density. Asking about her labs. She asked about her lipids but I advised I don't have those in her chart.
Medications: Caltrate 500 mg PO BID
Bisphosphonates with GERD/GI symptoms. We have stopped those. Bone denstiy 3/2007 with osteopenia only. R/b/se of evista discussed with her. She would prefer to continue with calcium, vit D, and weight bearing exercise and recheck bone density in 3/2009 and decide on further meds at that time.medically cleared for her cataract surgery however I haven't seen the copy of her EKG at this time (please get from Dr. Cardone). Avoid NSAIDs for 1 week prior and vitamin E. She will start asa 81mg per day after surgery is completed for general cardiovascular prevention.
 

Erica1217

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No you can not bill two E&M services for the same patient encounter. Look at ALL the documentation and choose the most appropriate code that represents the entire visit. If there really was a request for consultation from the surgeon, then bill a consult.

The ONLY time you can ever bill 2 E&M's is if they were done at separate encounters for different reasons.

Medicare Claims Processing Manual, page 39 - 40
http://cms.hhs.gov/manuals/downloads/clm104c12.pdf

"As for all other E/M services except where specifically noted, carriers may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician documents that the visits were for unrelated problems in the office or outpatient setting which could not be provided during the same encounter (e.g., office visit for blood pressure medication evaluation, followed five hours later by a visit for evaluation of leg pain following an accident)."

:) Erica
 

efrohna

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Heather,
You also want to be VERY careful on billing preoperative consults. Was there a request from another provider or appropriate source asking for an opinion, advice, clearance? And if so, Why? What is the intent of the clearance? Co-morbidity? Medical necessity?

Preoperative consults are high on the radar now, not only with CMS, but with other payers. All (3) R's of a consult need to be met in order to bill for it.
1. Request
2. Report
3. Rendering

In your detailed note, the exam is missing. For a consult you need 3 out of 3 components to determine that level. Was this an oversight? This looks like an office visit alone.

Good luck!
E. Frohna
 
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