Office visits and X-rays

jhyatt3080

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Really need some help coding ortho office visits and exams. Payers (specifically BCBS) are bundling office visits with X-rays! A patient presents for a recent injury, followed by pain, and X-ray results indicate a sprain. The physician charges a 9921x and an X-ray. Should we append a -25 modifier? And which charge should list which dx? Also, any suggestions on possible issues using the 729.5 (pain) dx?
 
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office visits and xrays

There should not be any reason payors are denying office visits with xrays. Only, if the patient has just recently had surgery and the global period is still in effect. In this case there would be no charge for the office visit, only if the doctors sees them for a different problem, then you would add modifier 24 to the office visit. I use pain codes all the time if that is the chief complain, such as 719.46 [knee pain], 719.44 [hand pain], and bill an office visit along with the xray we do in the office.

Hope this helps,
CW
 
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office visits withx rays

Forgot to mention that if this is an injury, you do need to put the date of injury or onset on the claim if you are using the 800 series ICD9 codes.

CW
 

mitchellde

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Really need some help coding ortho office visits and exams. Payers (specifically BCBS) are bundling office visits with X-rays! A patient presents for a recent injury, followed by pain, and X-ray results indicate a sprain. The physician charges a 9921x and an X-ray. Should we append a -25 modifier? And which charge should list which dx? Also, any suggestions on possible issues using the 729.5 (pain) dx?
i would use the 25 modifier, also per the coding guidelines you would not use the symptom of pain once you have the dx of sprain, unless this is a visit for pain control in which case you would use a 338.xx code for the pain followed by the sprain. But the provider must document that the reason for the visit is pain management and that the pain is either acut or chronic.
 
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