March 16, 2023 Question: In 2023 will the level of service be determined by history, exam and medical decision making or will this change. I have heard it is changing. Answer: Beginning January 1, 2023 consultation codes 99242-99255) for both inpatient and outpatient services will be based on medical decision making or time. However, keep...
February 16, 2023 Question: What is the difference between an implant and a foreign body? Answer: On page 74 of the Current Procedural Terminology (CPT) Professional Edition 2023, the definition was added to the guidelines. “An object intentionally placed by a physician or other qualified heal care professional for any purpose (eg, diagnostic or therapeutic)...
January 19, 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...
December 15, 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...
November 17, 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...
October 20, 2022 Question: My coder just told me that for Office E/M services 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 used to select a new patient...
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...
August 25, 2022 Question: We have been reporting CPT code 64625 with 3 units when we perform a radiofrequency ablation of the nerves innervating the sacroiliac joint at levels S1. S2, and S3. We have gotten several payer denials recently. Are we coding correctly? Answer: No, CPT code 64625, Radiofrequency ablation, nerves innervating the sacroiliac...
July 28, 2022 Question: I did a left hip intraarticular steroid injection and used fluoroscopic guidance. Can I report the guidance in addition to the procedure? Answer: Yes, you would report CPT code 20610 for the hip injection and 77002-26 for the fluoroscopic guidance. Make certain you use Modifier 26 when performing procedure is a...
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...
