Question: We have a Medicaid patient that came in for a ten year-old physical and was found to be sick, so we would like to append modifier 25 to report the well turned-sick visit. Is that accurate?- Virginia Subscriber Answer: Yes. In this situation, ...
Correct Coding Initiative version 17.1 brings 11,831 new edit pairs, effective April 1 for physicians. That’s the word from a March 17 announcement by Frank Cohen, principal and senior analyst for the Frank Cohen Group. Here’s a look at the major pointers you need to keep in mind to comply with the new cardiology-related edits, including cardiac catheterization, radiological supervision and interpretation, cardiac rehabilitation, and more.
1. Prevent Denials by Remembering 93454-93461 Are Diagnostic
New edits will prevent you from reporting heart catheter/angiography codes 93454- 93461 (column 2) with the following cardiovascular therapeutic services and procedures (column 1):
The 929xx codes in column 1 describe coronary therapies. The 934xx codes in column 2 are diagnostic procedures. You should never use the 934xx diagnostic codes in column 2 to report catheter placement and coronary angiography performed as an integral part of the therapeutic column 1 services.
Opportunity: The edits have a modifier indicator of 1, so you may override them with an appropriate modifier when the procedures are distinct. If you report both codes in the edit pair and don’t append a modifier to the column 2 code, Medicare (and payers applying Medicare rules) will reimburse you for only the column 1 code.
The AMA, via CPT Assistant (April 2005), indicates that you may report a true diagnostic catheterization in addition to the therapeutic procedures described by 92980 and 92982: “These two distinct procedures (diagnostic catheterization and therapeutic procedures), therefore, should...
You may need to append modifier 25, depending on payer policies.
Question: Our physician billed 90634, 90710, and 90606 for vaccines given to a 5-year-old patient. The insurance company denied payment and said they required a modifier. What should we…
Question: Could you please give me the most current coding guidelines for the MESA and TESA procedures? The last I was aware, we were to use unlisted procedure codes. Is that still correct? Answer: You should still use unlisted procedure codes to report microsurgical epididymal sperm aspiration (MESA) and testicular sperm aspiration (TESA, sometimes called TESE [...] Related articles: