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no more consults, which modifier?

  1. Default no more consults, which modifier?
    Medical Coding Books
    which modifier would i append to an initial visit code which really is a consult, the day before a colonoscopy or egd with medicare? 24 abd 79 both state unrelated service or procedure during global, but the consult is related.

  2. #2
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    Columbia, MO
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    you cannot use 79 on an E&M and 24 is for a service provided within the global, which an initial visit is not. The issue is if you knew the patient was comming to you as a referral for the purpose of a colonoscopy then you cannot charge for an initial encounter since the patient has already been seen by a different physician and has determined the need for the procedure. If the decision for a colonsocopy has not been made prior to the patient being evaluated by your physician then there is no need for any modifier, however you may need to provide documentation to prove that the patient was not sent for the purpose of the test.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    I believe my question is the same, my physician asked me if I knew about a modifier to add to H&P codes which has a higher reimbursement rate... Been moving 99254 to 99222 but am not aware of a mod to use..???

  4. #4
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    Columbia, MO
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    There is no modifier to add to a visit level to make it pay more or even equivalent to a consult. One of the benefits to Medicare and other carriers for dropping consults was the amount they would be able to save with the lower reimbursements. Sorry there is really nothing that can be done. The only available course to take would br prolonged time codes but there is documentation the physician must be willing to include for that to be done.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    DUTCHESSKG: It sounds like you are looking for the same info that I am. Take a look at this maybe it's what you are looking for.

    The principal physician of record will append modifier “-AI” Principal Physician
    of Record, to the E/M code when billed. This modifier will identify the physician
    who oversees the patient’s care from all other physicians who may be
    furnishing specialty care. All other physicians who perform an initial evaluation
    on this patient shall bill only the E/M code for the complexity level performed.

  6. #6
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    Columbia, MO
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    the AI modifier is for the admitting physician to use not the consultant and will not cause the E&M to pay more. There is no modifier for the E&M to increase the reimbursement, the only thing you can do is add on to the E&M with add on codes for prolonged time 99354-99357

    Debra A. Mitchell, MSPH, CPC-H

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