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2 E/Ms, one with mod 25

  1. #1
    Location
    Woodland Hills, CA
    Posts
    121
    Default 2 E/Ms, one with mod 25
    Medical Coding Books
    Hello all,

    Pediatrician has a nutritionist on site. Pt was seen by the pediatrician and the nutritionist on the same DOS.

    Can they bill 99244 and 99212-25 on the same claim?

    I don't think so, just want to hear other opinions.

    Would someone be able to explain in different ways or to support this with a web site or any documentation ?

    Any help and ideas would be greatly appreciated.

    Thanks,
    Lilit
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  2. Default
    Hi,
    Nutrition counseling is included in the CPT codes for preventive medicine services-
    If nutrition aspects dealt in a separate encounter, may be CPT code like 99402 tried-

  3. #3
    Location
    Woodland Hills, CA
    Posts
    121
    Default
    Hello, thanks for your reply.
    The visit was not for preventive medicine service, it just was a regular visit.
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  4. #4
    Default what are the diagnoses?
    Looks like you are billing and Consult and office charge - would need more information - was the patient seen for seperate reasons?

    Sometimes billing 2 office charges is correct - depending on the circumstances and diagnosis.

  5. #5
    Location
    Woodland Hills, CA
    Posts
    121
    Default
    Let me take a look at the records and I will get back to you....

    Thanks,
    Lilit
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  6. #6
    Location
    Louisville, KY
    Posts
    1,101
    Default
    Nutritionists/Dieticians cannot use E/M codes. They have their own service codes available in the Medicine Section of CPT. I cannot determine a reason you'd bill a consult for the services of a nutritionist.

    Good luck with solving this. I'd think that the correct code combination would be ok on the same claim.

  7. #7
    Location
    Woodland Hills, CA
    Posts
    121
    Default
    Oh, thanks Kevin very much for your reply.
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  8. #8
    Location
    Loma Linda CA
    Posts
    35
    Thumbs up 2 e/m 's same day
    Yes they can both be billed together - you have to make sure there is a condition code GO on the claim and the first e/m reguires a 25 modifier the second e/m would have to have 25, 27 in order for both services to be reimbursed.

    Mholland CPC

  9. #9
    Location
    Jacksonville, FL River City Chapter
    Posts
    74
    Default
    As Kevin pointed out, nutritionists can not use E/M codes. These codes represent physician services. A few specific types of non-physician practitioners, like PAs and ARNPs, who by the nature of their credential are allowed to provide services usually described as "physician" services, can also bill these, but this provision does not apply to nutritionists.

    Seth Canterbury, CPC, ACS-EM

  10. #10
    Location
    Columbia, MO
    Posts
    12,915
    Default
    Both Seth and Kevin are correct. Nutritionist do not use the E&M codes for their services, and the codes from the medicine secion are bundled with the E&M codes and for that reason the nutritionist visit is usually considered incidental and a part of the physician encounter. Depending on the documentation and the stated reason for the encounter you might could use the 98960 code for education and training for patient self management, which is not bundled with the office visit but carries only .66 RVUs.
    To address the response by mholland; Only a facility may bill two visit levels on the same day using the 27 modifier and the G0 condition code, this is not allowed for physician billing.
    Debra Mitchell, MSPH, CPC-H

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