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Drawing a blank...

  1. #1
    Question Drawing a blank...
    Medical Coding Books
    I don't think I should need a modifier, but I can't be sure, so I wanted to check...
    Patient comes in and sees Dr. A, and has laceration repair on their left shin. It's reported as: 99202/25, 12004/LT.

    3 days later, he comes back in with another cut on the same shin, in pretty much the same place. This time, Dr. B (who has the same specialty and tax ID), performs the services. According to the chart, the correct CPT's are 99212/25, 12002/LT.

    My question is, do I need any type of modifier on 12002, since it falls within the global period for 12004, and the patient was treated by another MD in the same group practice? I can't find any indication that I should need one, but this payer is extremely picky, and I'm probably going to have a hard time getting the second DOS paid as it is. Any input is appreciated!

  2. #2
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    Quote Originally Posted by btadlock1 View Post
    I don't think I should need a modifier, but I can't be sure, so I wanted to check...
    Patient comes in and sees Dr. A, and has laceration repair on their left shin. It's reported as: 99202/25, 12004/LT.

    3 days later, he comes back in with another cut on the same shin, in pretty much the same place. This time, Dr. B (who has the same specialty and tax ID), performs the services. According to the chart, the correct CPT's are 99212/25, 12002/LT.

    My question is, do I need any type of modifier on 12002, since it falls within the global period for 12004, and the patient was treated by another MD in the same group practice? I can't find any indication that I should need one, but this payer is extremely picky, and I'm probably going to have a hard time getting the second DOS paid as it is. Any input is appreciated!
    12002 and 12004 no longer have global days...

    Page 15

    http://edocket.access.gpo.gov/2011/pdf/2010-33264.pdf

  3. #3
    Wink
    Quote Originally Posted by RebeccaWoodward* View Post
    12002 and 12004 no longer have global days...

    Page 15

    http://edocket.access.gpo.gov/2011/pdf/2010-33264.pdf
    See? That's why you're the best! Gracias!

  4. #4
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    North Carolina
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    Nahhhhh...I have great colleagues; such as yourself!

  5. #5
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    Columbia, MO
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    FYI you do not use the LT or RT or 50 modifers on the 12002 or 12004 or any 12xxx codes as they are skin procedures, skin is one organ without laterality.

    Debra A. Mitchell, MSPH, CPC-H

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