June 30, 2022 Question: Can I use modifiers on an unlisted code? Answer: There is not a single right answer to this question. CPT said, in an old CPT Assistant, that generally modifiers are not appended to an unlisted code. Payors have their own rules. For example, some payors will accept modifier 62 (two surgeons/co-surgery)...
June 30, 2022 Question: I heard someone say the 2022 CPT manual will be updated in July with new codes. I have never heard of this before. Is this a rumor or will there be a new CPT Manual released in July? Answer: No, there will not be any changes to the 2022 AMA CPT...
June 30, 2022 Question: We just recently began hiring PAs to see patient to assist our pain physicians. Our pain doctors want the PAs to see new patients and bill under their NPI number. We see a large population of Medicare patients and I am worried this could get us into trouble. Answer: For Medicare...
June 30, 2022 Question: Does it matter that the open exposure codes are now add-on codes? Does that change payment or coding in any way? Answer: Yes, this change has both coding and payment implications. In terms of coding, the open exposure codes can now only be reported with a primary code; the main body...
June 30, 2022 Question: The guidelines that came out in 2021 for E/M services is for all types of E/M services, right? Answer: No. The 2021 E/M guidelines are for office/outpatient visit codes only (99202-99215). You will still need to use the 1995/1997 guidelines for all other E/M services, even consultations in the office. *This...
June 30, 2022 Question: I am new in Dermatology coding and am currently coding for a Mohs surgeon. I was instructed that if the patient comes in and does not have a confirmed malignancy based on a pathology report and the physician does a biopsy to confirm the malignancy prior to Mohs surgery we can...
June 30, 2022 Question: My coder just told me about the new guidelines for 2021 office visit codes. She said I no longer have to document a History. This doesn’t seem right to me. Answer: You are wise to ask because that’s not exactly true. It is correct that the History will no longer be...
June 30, 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...
June 16, 2022 Question: The patient had a re-do laminectomy for stenosis at L3-L4. Can code 63042 be used for this procedure? Answer: No. CPT 63042 is intended for a re-do discectomy and would be inappropriate to use for a re-do laminectomy. Rather, use 63047 for this service and modifier 22 may be appended if...
June 16, 2022 Question: I’ve heard you say to wait for the pathology report in order to bill for the skin lesion excision codes 114xx (benign) and 116xx (malignant)? What if I have a biopsy report – do I still need to wait? Answer: Good question – no you do not need to wait if...
