September 22 2022 Question: Can I use modifiers on an unlisted code? What about global period modifiers such as 58, 78 or 79? It seems reasonable to append those modifiers to the unlisted code. Answer: There is not a single right answer to this question. CPT said, in an old CPT Assistant, that generally modifiers...
September 22, 2022 Question: I am a contracted physician with a group practice (Practice A) in our town. I have an opportunity to contract with another practice (Practice B) not in the same town, but near enough that my patients could see me in either location. My question has to do with the definition of...
September 22, 2022 Question: I sent a patient out to the hospital for a CTA and the patient brought in the actual images and the radiologist’s report for me to review. Can I charge 76140 (Consultation on X-ray examination made elsewhere, written report) when I personally interpret those images and write my own report? Answer:...
September 22, 2022 Question: After a recent audit and review with my physicians, they are telling me that they do not need to document a history and/or exam any more for the new and established patients. That is not my understanding. Answer: You are wise to ask because that’s not exactly true; we hear it...
September 22, 2022 Question: Is code 42950, Pharyngoplasty (plastic or reconstructive operation on pharynx), reportable when a free skin flap with microvascular anastomosis, is not performed and a limited pharyngectomy is done? Answer: No, you should report CPT code 42890 when a limited pharyngectomy is performed not CPT 42950 (Pharyngoplasty (plastic or reconstructive operation on...
September 22, 2022 Question: When billing 4 units of 11620 (4 charges with 1unit a piece with 76 modifier) to a Medicare Advantage plans we are getting denied for MUE stating that 3 units can only be reimbursed on the same date. Will changing the modifier to 59 bypass this edit or is it Medicare’s...
September 22, 2022 Question: What modifier is used to report a colostomy revision during the global period of the stoma creation? Answer: A modifier 78, return to the OR for a related procedure, in this case a complication of the creation, would be appended. *This response is based on the best information available as of...
September 22, 2022 Question: In a recent head trauma case, a decompressive craniectomy was performed with a partial temporal lobectomy, due to extensive damage. A hematoma was also evacuated. can we bill for the 61323 decompressive craniectomy code with lobectomy since only a partial lobectomy was done? And what about cooing for the hematoma evacuation?...
September 8, 2022 Question: Can I bill an office visit in the global period if the diagnosis is different from why I did the original procedure? Answer: Yes, as long as the diagnosis is not for a related issue (e.g., complication from the original procedure). The documentation must be clear that the condition is unrelated...
September 8, 2022 Question: The surgeon used a stent and then inserted an embolization coil for an aneurysm. Are both billable? Answer: If the stent is placed to provide a latticework for deployment of the embolism coil, then no. You would just bill for the embolization. If the stent itself is the sole definitive procedure...
