# Correct Coding for 99203 within 3 years



## jan64govols@msn.com (Jun 29, 2012)

I work for an orthopedic group and per Medicare guidelines we can charge a new patient visit within the three year period if the patient sees another physician  because sports medicine is now its own specialty.  The patient is seeing another doctor in the group.  It was originally coded at 99203 with a 24 modifier.  Medicare rejected as modifier inconsistent with procedure code. I thought this would be incorrect in the first place as the description states that the 24 modifier is a separate e/m service within the post operative period by the SAME physician.  The patient is actually seeing a different physician for a different problem not related to the surgery.  However she is within the global period on a surgery by the first orthopedic doctor.   Can someone help me with the correct coding for this scenario?


----------



## tdml97@yahoo.com (Jun 29, 2012)

I think you are going to have to bill it as established - did you call Medicare & verify rejection?


----------



## Naveen Rachagolla (Aug 22, 2012)

I think there is no need to append modifier 24, because you are coding it as a new patient  as sports medicine is own speciality and more over The patient is actually seeing a different physician for a different problem not related to the surgery which was performed previously.  If the patient has went to another physician who is in the same speciality under same group then you can  code it as new patient. I guess here you should code it as established patient if the physician is under the different group ID.


----------



## jbrightw (Aug 22, 2012)

Modifier 24 states 'Unrelated E/M service by the *same* physician during a postoperative period'. But here the patient is seeing a differant physician and you have assigned 99203 as new patient. Till here you are correct.

Modifier 24 always to be assigned with established visits, because when a patient come to the same physician during a global period, it must be an established visit (9921X).

For new patients please dont use 24 modiifer. Am I right?

Brightwin


----------



## zoolug (Sep 4, 2012)

*24 should be on an established code*

I agree with Brightwin. 24 does not make sense with a new patient code, which seems to be what medicare is saying. I think you can code it with 99203 and no modifier. I can't swear Medicare will recognize that the specialty is different and pay it, but that seems like the right way to code it.


----------



## dclark7 (Sep 7, 2012)

You should not need a modifier for this visit.  However you do need to make sure that the physician's specialty with Medicare is listed as sports medicine.  Physicians self designate their specialty in PECOS, so even though the specialty is recognized, if the physician is not credentialed under that specialty code (23 for Sports Medicine, 20 for Orthopedics) Medicare will not recognize him as a different specialty.


----------

