TriZetto Provider Solutions is a healthcare IT subsidiary of Cognizant Technology Solutions that provides revenue cycle management and claims processing services to physicians, hospitals, and health systems. Trizetto has experienced a significant data breach of patient information.
“A new patient was seen with heel pain. X-rays were taken at an outside facility, and I independently interpreted these and reviewed the labs. Based on medical decision making, I believe I should be coding E/M code 99204. The patient had one new, acute problem (previously undiagnosed) and I independently interpreted tests. To me this is a no brainer, but my office staff argues that they believe it should be E/M code 99203.”
“The patient initially had a gastroc recession at the right lower extremity. Our surgeon performed a debridement procedure for the right foot ulceration. It was performed in the clinic, and we planned to code it as CPT 11042. However, the patient is in the 90-day post op period from initial surgery that was performed 4 weeks ago. Is a modifier necessary to submit for payment? Is it 79?”