November 30, 2023 Question: My physician is billing office visits 99202-99215 based on time only. Is this best practice? Answer: The E/M services 99202-99205 are based on either medical decision making or time.. Practitioners may choose to either bill by time or medical decision making. The practitioner should evaluate each patient encounter to determine which...
November 16, 2023 Question: I have a question regarding 2023 shared visit rules. I am reviewing an E&M note where I will select the level of E&M based on the MDM being the substantive part and not time. My question: does each provider have to document their individual time if not a factor in the...
November 2, 2023 Question: Our physicians’ defaults to time for almost every office encounter. We are working with them on documentation and what work contributes to total time and what does not. They perform their own independent interpretation of X-Rays (we bill globally) and performs procedures such as for example a shoulder injection or a...
October 19, 2023 Question: We are submitting a hospital claim form with the modifier 25 and FS modifier. We are unsure which modifier to list first. What is your recommendation? Answer: Thanks for contacting KZA and remembering to use the FS modifier for shared services provided in the hospital. KZA recommends placing modifier 25 first,...
October 5, 2023 Question: My doctor performed chemodenervation on all four extremities using needle electromyography. We use CPT code 95874 for the electromyography. My question is do I only report CPT 95874 once for all 4 extremities or can I report 95874 it for each extremity. Do I need to add Modifier 59? Answer: Yes,...
August 3, 2023 Question: When reporting an injection of a steroid of the brachial plexus can I report imaging such as ultrasound guidance? Answer: CPT code 64415 is reported for a injection of an anesthetic agent and/or steroid of the brachial plexus. Per CPT imaging guidance is included in the code and cannot be reported...
July 6, 2023 Question: How is RFA rhizotomy of the trigeminal nerve at the second and third division branches of the foramen ovale? The diagnosis was Trigeminal Neuralgia Answer: This procedure is coded as 64605, Destruction by neurolytic agent, trigeminal nerve second and third division branches at foramen ovale. Code +77002 may also be reported...
June 8, 2023 Question: What CPT code do we use when our physician performs an SI joint injection using ultrasound guidance? CPT code 27096 states with fluoroscopy or CT guidance. Answer: CPT instructs to report CPT code 20552 for unilateral or bilateral SI joint injections if CT or Fluoroscopic imaging is not used. CPT code...
May 11, 2023 Question: What does “separate procedure” mean when it follows a CPT code description? Answer: Per CPT : Some of the procedures or services listed in the CPT codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term...
April 13, 2023 Question: We have a patient with 2 commercial payers (BCBS and Cigna). A consultation code was submitted to BCBS, and they paid according to our contract. However, Cigna is refusing to process the claim since they no longer pay for consult codes. Am I allowed to change the CPT code and rebill...
