Anesthesia Coding Alert

READER QUESTIONS:

Careful Appending Modifiers to 99201

Question: Our physicians must write the history and physical (H&P) for surgery on podiatric patients since the podiatrists cannot. I have been billing E/M 99201, but the insurance companies reject it, saying it is incidental. Is there any way I can get reimbursed for doing this H&P for the podiatrist? Texas Subscriber Answer: The presurgical H&P is often a facility requirement and considered by many payers as not a medical necessity -- that is, not separately payable. A preoperative anesthesia evaluation is required and included in the global anesthesia fee as part of the base units. Generally, avoid appending modifiers to an E/M code such as 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Anesthesia Coding Alert

View All