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99024 with 99213 ??

  1. Cool 99024 with 99213 ??
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    We have pt's that have abscess and they have to come back every day for drainage and changing dressings. But the insurance is not paying for the subsequent visit. Should we use wound check V58.32 as primary dx and 682.9abscess as secondary, after the initial visit. Can we use 99024 and E/M service if they also have other issues?

    Thank you all in advance.

    MsMaddy

  2. #2
    Location
    Salt Lake North
    Posts
    640
    Cool
    99204 is a New Patient visit. Any and all services done on the date of the initial visit are reported with the New Patient code. If the patient returns for any reason, those services are added to the previous services and the "work" of those two visits is added up to calculate your new visit code. You can't bill a new and established patient visit on the same date. The problem is not your diagnosis coding, but your procedure coding. The insurance company is correct in denying the second visit on the same date. I hope that this helps.

  3. Smile
    Quote Originally Posted by quinnwebb View Post
    99204 is a New Patient visit. Any and all services done on the date of the initial visit are reported with the New Patient code. If the patient returns for any reason, those services are added to the previous services and the "work" of those two visits is added up to calculate your new visit code. You can't bill a new and established patient visit on the same date. The problem is not your diagnosis coding, but your procedure coding. The insurance company is correct in denying the second visit on the same date. I hope that this helps.
    I think you missed read cpt code on my note, it's 99024 not 99204.

    Thanks
    MaMaddy

  4. #4
    Location
    Salt Lake North
    Posts
    640
    Default Sorry for the dyslexia
    If the patient is comming in for surgical after care within the global period, I don't think that I would even use 99024 unless it was the only service performed that day. I think they use it to keep track of visits and would not be paid. If the patient comes in for something that is not related to the surgery, then yes you can bill it. As long as you can show a HX, Exam and MDM for it, you could bill it. I would include a -24 modifier to let the insurance company know that it's not related to the surgical services. I also could find no prohibition in the NCCI idits for 99024 and 99213.

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default Surgical after care
    If the patient is presenting to the office for a routine post-op visit then the 99024 code can be used for tracking purposes (we do not even send a claim to insurance).

    If the patient has issues unrealted to the surgery, and an E/M is performed, that service can be coded as an established patient visit (level based on documentation) with a -24 modifier. BUT ... this has to be a problem unrelated to surgery ... NOT a chronic condition that just happens to exist.

    So, for example, your abscess patient comes to the office 3 days after I&D for a wound check. This patient happens to have DM. You do NOT code an established office visit just because the patient happens to have a chronic condition.

    On the other hand, your abscess patient comes to the office 3 days after I&D for a wound check, and also mentions that he has a cough, sore throat and feels feverish. The workup of these URI symptoms (or possible flu) is completely unrelated to the abscess and I&D and would be coded separately with a -24 modifier.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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