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Boss wants an Answer

  1. Question Boss wants an Answer
    Medical Coding Books
    My boss approached me today questioning why we can not bill 2 E/M codes in the same if:
    A patient comes in to see a provider in the morning for a f/u on her gallbladder and then later in the day she is seen again by the same provider urgerntly for a laceration to the hand; a cut from a kitchen knife.
    My boss is particularly looking at the Modifier 25 to attach to one of the 2 E/M codes since the OV's are seperately identifable services. I couldnt give her the answer she was looking for/a concrete answer. HELP Please!!

  2. #2
    You can bill for both of these visits since they are unrelated. The information is in CMS' Medicare Claims Processing Manual, 100-04, under Chapter 12 for Physician services, section 30.6.7 Payment for Office or Other Outpatient Evaluation and Management. Section B.

    You would need the 25 modifier on the second E/M and it may be denied but you could appeal with documentation.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  3. #3
    Milwaukee WI
    Default Is the first visit postop?
    I'm not sure I correctly understand the original post ... but if the first visit is follow-up for gallbladder removal it may be in the postoperative period and should be coded as 99024. The hand laceration visit would then be coded as per documentation with a -24 modifier (unrelated to global period).

    If there is no post-op global period, then I agree with Pam.

    F Tessa Bartels, CPC, CEMC

  4. Default
    OK. I think I should specify as to what type of office visit issue we are having... Ex: can we code a 99214 twice in one day, or 99212 and 99214 for the same patient on the same DOS. In reference to the initial post.
    If this is not allowed, why not?
    I understand we bill a critical care service w/ an outpatient OV (this I knew).

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