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Thread: Help with coding and modifiers

  1. #1

    Default Help with coding and modifiers

    AAPC: Back to School
    Hi all,

    I sent an SOS out a few months ago when the doctor asked me to do his billing. At the time, his provider enrollments were not complete. Today they are complete and he is seeing patients and I am at a loss.

    I currently bill for an Internal Medicine doc. Simple 99213/14 office visits with Dx and done!

    My biggest concern with this doc is bundling and MODIFIERS. I hate modifiers!!!

    Any info you can give would be greatly appreciated. Info on common modifiers used, books, CD's anything. Here is an example of two superbills. What mod's would be used and on which procedures if any ??????

    Thank you so much in advance!

    Number 1
    99204 office visit
    81000 Urinalysis
    51798 PVR Bladder

    Number 2
    99204 office visit
    76872 Ultrasound prostate
    55700 prost BX pac
    76942 US guide inj
    51700 supplies

  2. #2


    depending on your location and if the Dr. owns the equipment...

    I code for a hospital, the provider is under the hospital


    Number 1
    99204 office visit
    81000 Urinalysis
    51798 PVR Bladder

    99204 -25 modifier
    81000 or 81003

    Number 2
    99204 office visit
    76872 Ultrasound prostate
    55700 prost BX pac
    76942 US guide inj
    51700 supplies

    99204 -25 modifier (if the documentation supports a separate E/M form the procedure)
    76872 -26 modifier for the professional
    76942 -26 modifier

    we do not bill for the supplies, they are included in the procedure.

    Again this will depend on your location.

  3. #3


    Thank you those modifiers help. I am trying to code all of the above from the doctors private office.

    Thanks again!

  4. #4

    Default Modifiers

    It also depends on the insurance company being billed. For Medicare you won't need the modifier 25 on the office visit w/the post void residual. But for private pays such as BCBS, UHC...you would put the modifier.

    Also if you are doing the biopsy in the office you would not bill for an E&M visit unless it was for a separate diagnosis from the biopsy. Such as patient has the biopsy for an elevated and after the biopsy he tells you he has pain (maybe a kidney stone) and you do a workup for that.

    Wendy R. Weaver, CPC
    Office Manager
    Urology Clinic of South Alabama, LLC

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