Wiki Consult with Scope

[pinnaclephyserv]

If a patient comes in for a new patient consult and then requires a scope, but the doctor only gives one dx.... Can we bill the consult with the scope with a modifier 25??? Is there any links/information you can send to me.

Thanks,

PPS

 

[mitchellde]

Yes you can! In the CPT book in Apendix A look at definition under the 25 modifier. It states"As such separate dx are not required...."

 

[panderson]

If the decision for surgery was made at the time of the initial consult and the scope has global days of 90, 57 modifier may be more appropriate.

 

[jackjones62]

Michellede is absolutely correct, as long as your documentation supports an E&M as well as the scope, you can bill the E&M w/Mod. 25 & the scope with one diagnosis; Mod. 57 w/b inappropriate in this scenerio.

Jennifer
CT ENT