Advanced Search

Ob-Gyn Coding Alert

Reader Question:

Using a Modifier with 99204

Published on Sat Jan 01, 2000

Question: A new patient comes in for diagnostic code 626.2 (excessive or frequent menstruation), CPT 99204 (new patient visit; comprehensive history and examination, moderate-complexity medical decision-making), plus 622.7 (mucous polyp of cervix), 58558 (hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C.) [formerly 56351]. Do we use a modifier on the 99204?

Barbara Detwiler
Jefferson Healthcare
Collegeville, Pa.

Answer: Yes, you have to use modifier -25 on the office visit (99204). Even though there is a different diagnosis (622.7), most carriers computers screen for the appropriate modifier before reviewing the diagnostic code. The claim will be kicked out at the first sign of error.
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

Ob-Gyn Coding Alert

View All