Practice Management Alert

Question: We submitted a claim on July 17 for an FNA service performed on July 15. We received a denial. Our practice is owned and operated by the hospital. Our doctor performed a fine needle aspiration (FNA) of a patient's mass at our clinic on July 15. The pathology report indicated that the patient needed an excision so the doctor admitted the patient to the hospital on July 17 for that procedure. We billed 10021. What did we do wrong? New York Subscriber Answer: Because your practice is owned or operated by a hospital, you need to append modifier PD (Diagnostic or related nondiagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days) to the FNA code. You can bill the FNA using 10021-PD (Fine needle aspiration, without imaging guidance). The modifier effectively turns the clinic-based [...]