Wiki 99499 Advise

[jeaner54175@yahoo.com]

I have a provider who uses 99499 when a patient comes in for laceration repairs. She says she was told to code the evaluation and managment as unlisted because it brings in more revenue and it is appropriate. I think we should be coding using an E/M code for a new or established patient along with the repair code. If anyone has any insight on how to code this I would appreciate it.

Thanks,
Lisa

 

[Amy Pritchett]

99499 Question

You are absolutely right to question this. The provider should always bill an Evaluation and Mangement code that is representative of what service they performed. Then a -25 modifier should be attached to the appropriate E/M code along with the codes for the suturing of the lacerations.
You should never bill an unlisted code unless there is no other code in the CPT that furnishes you the correct description of the service provided.
Reference:
http://www.hcpro.com/HIM-253718-816...service-really-above-and-beyond-the-norm.html

Hope this helps

 

[mlbaker1974]

You are absolutely right to question this. The provider also needs to be educated regarding the guidelines. Coding an unlisted code just to recieve more revenue is fraud.