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help with coding physical and e/m same day

  1. Talking help with coding physical and e/m same day
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    Can someone please help me?
    here is my issue- our new office manager wants me to code a physical with the the v70.0 icd9 code on the next line code the office visit with a 25 modifer(I say 59) only use the icd 9 codes for the office visit. she litterally has me take the v70.0 off the dx line. also if you are doing a physical on a pt along with an ekg/ecg do you use the 25 modifer? if so do you put it next to the procedure or the physical? thank you for any help

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    I code these all day--bill like this: 99213-25, 99396, 93000, dxs like, 401.9, 272.0, 250.00, V70.0 (as examples). Match the dxs to the CPT, 401.9 for 99213-25, V70.0 for 99396, and depending on you carrier for the ekg, V70.0 or 401.9, 272.0. If you have a lot of procedures--some carriers bundle things together--(BX and other carriers will bundle and ekg with a wart removal for example, even though the dxs are completely different) and you can avoid this with attaching a mod-59 to one of the cpts. It's not by the book coding, but you have to adapt to the carrier to get paid for all of your doctor's work.

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    It is not appropriate to add a 59 modifier to get things paid.
    Dee
    CPC, CPCO, CPMA, CPCD

  4. Default
    Quote Originally Posted by foley85255 View Post
    Can someone please help me?
    here is my issue- our new office manager wants me to code a physical with the the v70.0 icd9 code on the next line code the office visit with a 25 modifer(I say 59) only use the icd 9 codes for the office visit. she litterally has me take the v70.0 off the dx line. also if you are doing a physical on a pt along with an ekg/ecg do you use the 25 modifer? if so do you put it next to the procedure or the physical? thank you for any help
    The 25 modifier is appropriate when coding a preventive medicine visit. The preventive medicine visit would be the only one receiving the v70.0 and the additional e/m (99381-99397) would only get the dx that are above and beyond the preventive visit.

    When calculating the e/m you can only use the items from the HPI, exam and medical decision making that pertain to the addtitional e/m. For example, if your provider does his physical and finds the patient has an enlarged liver and icteric sclera (jaundice) and begins a liver workup and discusses patients alcohol consumption then only that piece of history and the 2 related body areas should be used to calculate the additional e/m.

    25 modifier is only for the e/m and would not be appended to the ekg or any procedure.

    The 59 modifier is over used and often used incorrectly. It is often called the 'unbundling modifier' but unbundling for payment puposes is inappropriate. Please see this site: http://www.cms.gov/MLNProducts/downl...NCCI-Tools.pdf


    Per CMS: http://www.cms.gov/NationalCorrectCo...modifier59.pdf
    Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter,different procedure or surgery, different site or organsystem, separate incision/excision, separate lesion, orseparate injury (or area of injury in extensive injuries)not ordinarily encountered or performed on the same day bythe same physician. However, when another alreadyestablished modifier is appropriate, it should be usedrather than modifier 59.
    Dee
    CPC, CPCO, CPMA, CPCD

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