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Thread: Modifier 25 - I code for a group of hospitalist

  1. #1
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    Default Modifier 25 - I code for a group of hospitalist

    Promo: Code Books
    I code for a group of hospitalist. They have "discovered" the CPT code 99358They use it along with their subsequent visit codes- 99231,99232, and 99233 Does the 99238 need a modifier 25 or the subsquent visit codes?

    Thanks for your help.

    cld

  2. #2
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    no need for a 25 the 99358 is an add on code. just be sure they are documenting time spent not only face to face with the patient but also floor time as it relates to that patient. if time is not documented they should not be using the 99358.

  3. #3
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    Thanks for taking the time to answer my question.
    cld

  4. #4
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    Default 99358 NON face-to-face

    99358 is specifically for NON face-to-face time spent in reviewing extensive patient records, communicating with other care givers, etc.

    Do NOT include the face-to-face time of the E/M code in calculating the time spent for 99358. Time must be documented; time must be at least 30 minutes beyond the E/M service before you can code this.

    F Tessa Bartels, CPC, CEMC

  5. #5
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    Thanks for catching that Tessa! I was off by a code section. Tessa is correct no face to face time on that one.

  6. #6
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    yes, prolonged services codes are necessary esp in inpt setting to maximize reimbursment. And it strengthens the case for using time-based coding as your primary method of determining E/M levels.

    I advise my providers to make sure to document why the extra time was needed - ex: (I spent the additional time reviewing old records, lab results, coordinating care with other physicians, etc.)

    Just makes for stronger documentation in an audit.
    Brad Howard, CPC, AHIMA Approved ICD-10 CM/PCS Trainer
    McKesson Specialty Health
    brad.howard@mckesson.com

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