Skip to main content
  • Helping you with HIPAA Security Solutions.
  • Call Us (631) 403-6687
  • Office HrsMon - Fri: 9.00am to 5:00pm

Modifier

Emergency Room Encounter With Surgery
Coding

Emergency Room Encounter With Surgery

by Michael Warshaw, DPM, CPC

“If a Medicare patient is seen in the emergency department and then surgery is performed later that day or night, can the emergency department consult be billed with a modifier -57 along with the surgery? We have been under the impression that, at least in the office, the visit to decide to do the surgery is included in the surgical fee. Are we correct and does this apply to the encounter in the emergency department too?”
Read More
E/M Coding
Coding

E/M Coding

by Michael Warshaw, DPM, CPC

“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 CPT 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 CPT 99203. Thoughts?"
Read More
Debridement In The Post Operative Period
Coding

Debridement In The Post Operative Period

by Michael Warshaw, DPM, CPC

“The patient initially had a gastroc recession at the right lower extremity. Our surgeon performed a debridement procedure of 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 the initial surgery that was performed 4 weeks ago. Is a modifier necessary to submit for payment? Is it 79?”
Read More
How are the FX and FY Modifiers Used?
Coding

How are the FX and FY Modifiers Used?

by Michael Warshaw, DPM, CPC

How are the FX and FY modifiers used?
Read More
What are the Appropriate Modifiers to Use for the Billing of CTPs?
Coding

What are the Appropriate Modifiers to Use for the Billing of CTPs?

by Michael Warshaw, DPM, CPC

What are the appropriate modifiers to use for the billing of CTPs?
Read More
Coding

Knowing When it is Correct to Bill an E/M Service and a Procedure on the Same Date of Service

by Dr. Michael Warshaw, DPM, CPC

Based upon an article that is posted within The American Institute of Healthcare Compliance website, it is important to note that the OIG is Auditing for Abusive Dermatology Claims. The Office of the Inspector General (OIG) is auditing dermatologists for billing an E/M service on the same date of service that a minor surgical procedure (ie. postoperative global period of 0 or 10 days) is performed. Medicare only covers Evaluation & Management (E/M) services on the same day as a minor procedure if a physician/surgeon performs a significant and separately identifiable E/M service that is unrelated to the decision to perform the minor surgical procedure. In order to bypass the CCI edits or the Correct Coding Initiative edits and bill for the E/M service and the minor surgical procedure/CPT code on the same date of service, the 25 modifier needs to be appended to the E/M service.
Read More