CODING & DOCUMENTATION
Fam Pract Manag. 2019 May-June;26(3):31.
Author disclosure: no relevant financial affiliations disclosed.
- SAME-DAY RETURN VISIT
- MODIFIER FOR INCIDENT-TO SERVICES
- INPATIENT CARE BILLING BY TEACHING PHYSICIAN
- BIOPSY OF THE OUTER EAR
- MULTIPLE X-RAYS
SAME-DAY RETURN VISIT
If a physician sees a patient and instructs him or her to return later that day for a blood pressure check, should our practice bill CPT code 99211 with modifier 25, “Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service,” in addition to the code for the first encounter?
No. You should charge one E/M code for the combined services. Payers typically follow guidance from the Centers for Medicare & Medicaid Services that says two separate office E/M codes may be reported on the same date only when the patient presents for two unrelated problems.
MODIFIER FOR INCIDENT-TO SERVICES
Does Medicare require using a modifier to show that an advanced practice provider such as a nurse practitioner or physician assistant provided an office E/M service incident-to a physician's services and billed under the physician's provider identification number?
No. But some health plans require modifier SA, “nurse practitioner rendering service in collaboration with a physician,” for services rendered incident-to or as a shared visit (e.g., the physician and advanced practice professional each provide significant portions of an E/M service). Though HCPCS specifies “nurse practitioner” in the descriptor, modifier SA may also be used when billing for services provided by physician assistants, clinical nurse specialists, or other advanced practice professionals specified in a payer's policy.
INPATIENT CARE BILLING BY TEACHING PHYSICIAN
If a resident does an inpatient history and physical examination (H&P) and discusses it over the phone with an attending physician on one calendar day (e.g., 10 p.m. Thursday), and the attending doesn't round on that patient until the next calendar day (e.g., 10 a.m. Friday), can the attending use the resident's documented H&P to
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Send questions and comments to email@example.com, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.
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