Wiki surgical codes

[mhernandez-veloso@att.net]

hello,
My doctor is a General Surgeon and he bills the 99221 with the surgery code done on the same day. I always get paid for the surgery code, but the consult gets denied as inclusive. Can you advise me on how to bill it so I can get the consult paid as well?
thank you =)

 

[TiffianyEdwards]

Modifier

From what I remember about hospitalist coding if two providers bill for that 99221 on the same day usually the first one is paid. I had to use an AI modifier to distinguish between my hospitalist and my pecialist. You may need a modifier or you may need to check the Carrier to see if they have specific guidelines for consults and surgeries done on the same day they could be bundled, and it will only be the surgery that gets paid.

 

[thomas7331]

If it's a major procedure, you would need a modifier 57 on the E&M code, for a minor procedure, modifier 25, of course assuming the documentation supports the modifiers. I've found that even with the modifier, some payers will still deny the E&M and you may have to appeal with notes.