Preventive, E/M, Multiple Procedures all in one visit

MandyBMC

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Hello!

We had a patient in our office who had multiple procedures done in one day and we are stumped on how to code this. We are billing this patient for a preventive visit, e/m, and 2 procedures.

This is what we are billing:
99396 - Preventive established patient 40-64 yo
99214, 25 - E/M established patient; significantly separately identifiable E/M service by same physician on same day
58301, 59 - IUD removal ; distinct procedural service
87880 - rapid strep

Should there also be a modifier on rapid strep? I have read to not use modifier 59 multiple times on a claim. In what instances is modifier 99 used? Would it be appropriate in this situation???? Confused on this one:confused:

Any help would be appreciated!

Mandy
 

RebeccaC

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The quick answer would be 87880 should have the QW modifier if performed in office. The 25 should be on the E/M as you indicated. I don't see anywhere on these 3 codes that requires any 59 according to NCCI edits.

I can definitely see the possibility of an appeal with office and procedure notes requested to get paid properly though. Hope this helps!


Rebecca C, CPC, CPMA
 

MandyBMC

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Thanks so much for your response, Rebecca! It looks like the QW modifier is what we were missing.

In the past when we did not use 59 on a procedure, the insurance made a global adjustment on it and we didn't get paid. Going forward when we added modifier 59 to additional procedures, we did get paid, so that's why we are inclined to use that.

Do you have any insight on modifier 99? What is a case in when that would be used?

Thank you,
Mandy
 

CodingKing

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Thanks so much for your response, Rebecca! It looks like the QW modifier is what we were missing.

In the past when we did not use 59 on a procedure, the insurance made a global adjustment on it and we didn't get paid. Going forward when we added modifier 59 to additional procedures, we did get paid, so that's why we are inclined to use that.

Do you have any insight on modifier 99? What is a case in when that would be used?

Thank you,
Mandy

Modifier 99 is from back when computer systems couldn't handle more than 1 modifier. There shouldn't be a need to use 99 anymore.

What's the sick E&M for? If patient mentioned they had a sore throat during their physical and had a rapid strep test only, the test would be billable. believe contraceptive counseling is a component of an age appropriate female physical so you wouldn't get to bill separately for that at it would be included in the preventive exam. Also the standard global surgical package would cover some of the pre-op work.
 
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