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Modifers

  1. #1
    Default Modifers
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    My questions is that the patient came in for a preventative code 99394 but then also had a wart tx 17110. I did put modifer 25 on the preventative code. Then I got denied because he had a toenail removed prior to the wart tx so within the global period of the wedge. I tried putting modifer 25 on the 99394 and modifer 24 on the wart tx. Is this not correct? All your input is greatly appreciated.
    Last edited by bkp385; 01-19-2009 at 12:24 PM. Reason: misspelling

  2. #2
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    the .24 doesn't belong on the cpt procedure... I'd put a .24.25 modifier (in that order) on the preventive code... it should get it out of the "global" issue and allows for the new procedure (wart).
    Donna, CPC, CPC-H

  3. #3
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    You also need mod -79 on the procedure.
    Lisa
    Lisa Bledsoe, CPC, CPMA

  4. #4
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    ok, feeling kinda lost.... If the patient is in a global period for a previous problem/treatment....how can you bill for a preventative visit afterwards?

    Sorry if this is corny, but I dont do preventative so I am trying to understand this concept. (seems to me this would be either a post op visit andnew problem encountered, thus a regular established visit with modifier since in global). ?????????

  5. #5
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    good catch Lisa - yes, you'd need that modifier on procedure too!

    Mary, (I'm just guessing here) but, maybe it was just time for their yearly check up ... (happened to fall right after their initial issue (toenail thingy)..
    (at least that's what I'm thinking anyway)
    Donna, CPC, CPC-H

  6. #6
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    Thanks Donna - and I agree with your comment about timing for the visits. My guess is this is a Family Practice or Internal Medicine.
    Lisa Bledsoe, CPC, CPMA

  7. #7
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    Thanks for all your replies. We are family practice so it was just time for their physical. This was great help.

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