READER QUESTIONS:
Careful Appending Modifiers to 99201
Published on Fri Mar 20, 2009
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 [...]
