Wiki Correct billing?

[ollielooya]

Doctor is endocrinologist. Patient was seen 6 wks ago for dx 241.1.(nontoxic multinodular goiter). Other issue addressed was 272.4 (other and unspecified hyperlipidemia). FNA scheduled.

Patient presents now for FNA and physician has submitted:
99214 (241.1, 272.0)
11021 (241.1)

I have my doubts as to whether a modifier 25 would be applicable in this situation, and have requested chart notes. Even so, am wondering if even the office visit IS billable and at such a high level for a 272.4, especially since the procedure was prior scheduled?

Thoughts, please as I await the chart notes....

 

[judy.rosenberg]

Correct Billing?

The FNA was scheduled at the last visit and therefore a separate E & M for that service is not appropriate, because the decision to perform it was already made. However, if a totally separate E & M was performed for ICD9-CM 272.4, it would be appropriate to review the notes and pull out the documentation applying to 272.4 only. It is my assumption it would probably support CPT 99212, certainly not 99214 unless there have been major changes since it was last reviewed at last visit. If a totally separate E & M was performed, modifier 25 could be appropriate and the office visit would be mapped to ICD-9-CM code 272.4 only. The FNA would be mapped to ICD-9-CM 241.1 only.