Wiki Coding question

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To bill an xray code of 73600 w/ a new patient visit code 99204, Is there a modifier needed? Also, Can both visit and x-rays be paid for? The visit came back inclusive w/ 73600.
 
Linki said:
To bill an xray code of 73600 w/ a new patient visit code 99204, Is there a modifier needed? Also, Can both visit and x-rays be paid for? The visit came back inclusive w/ 73600.
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per CCI edits, no modifier is needed for these 2 services.
 
Linki said:
To bill an xray code of 73600 w/ a new patient visit code 99204, Is there a modifier needed? Also, Can both visit and x-rays be paid for? The visit came back inclusive w/ 73600.
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Hi there, As lgardner notes, there isn't a CCI edit for those codes and modifiers should be used with care. If the denial came from a private payer you'll need to check their coding edits system and other policies. And of course, payers do make mistakes so don't hesitate to reach out to the payer. My only other thought is to make sure you don't count the x-ray toward the visit.
 
lgardner said:
I would be careful about using a modifier when it isn't required. Especially modifier -25.

Payers seem to be cracking down on the overuse of modifier -25.
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actually i am very glad you said that... i accidentally deleted my comment. anyways i was questioning that today. I still have ALOT to learn and have started to realize there is a larger world of coding out there that i have not been exposed to since i work for a FQHC... and when i first started 3 years ago doing charge review at the office i was taught rule of thumb if there is anything else does during the visit and it has a dollar amount add modifier 25. Well now 3 years later i am in billing and handle all of the coding issues under the supervision of our director. until i am certified. but i have a patient who was seem for TMS treatments and every date of service is coded almost identical
90868
99212-25
Dx F33.2 and F41.1 99212
F33.2 for the 90868
99212 is in fact a column 2 code to 90868.
and capital is denying a majority of the 99212 and just paying the TMS. but it is not consistent i have tried doing investigations with them as to why they pay some but not all. there is no difference. but cannot get an answer. which during my research started question why we bill the 99212 with the 25 in the first place.. there is nothing significant, separately identifiable about the visit and it definitely is not distinct in anyway but it does seem that although all of the claims were from Oct of 2022-December of 2022 we had issues with the prior auth and corrected claim etc the ones that were actually processed within the 2months are all denying the 99212 but the ones that were paid in 2022 are paying. I am still learning A LOT. and also take into consideration that we do have to do things differently being a FQHC but that is quite interesting. I don't handle any of the before hand coding that is done by charge review staff at the office still. we use EPIC and have a good amount of edits built in but i do all the denial follow up. so i will definitely be asking for clarification!
 
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