cwalker042
Guest
I just started coding for a derm practice and have a few questons regarding modifiers:
1) Provider performs procedure with global period. A few days later patient comes back in for another procedure (different area of the body) and the doctor codes an E&M with the procedure. Now, the doctor does not mention this issue in the previous office note which is why he is coding an E&M along with the procedure. We bill out the E&M with a 24 mod and 79 on the procedure and the carriers are denying inclusive. If we put a 25 mod on the E&M the carriers deny for being part of the global surgical package. I've been told that we are not supposed to put a 24 and a 25 on an E&M visit. Please share your thoughts/experiance with this.
2) Doctor performs MOHS (no global) and a different provider within the same practice does the complex repair who is a plastic surgeon which has a global period. When patient, again, comes back for another procedure (different area of the body) the doctor who performed the MOHS (no global) is billing an E&M with a 25 and a procedure. Carriers are denying as being part of the global surgical package. It's my understanding that it doesn't matter who the doctors are, if they are within the same practice, same TIN, the services provided in the global period will need the appropriate modifier. Can someone clairfy this for me
3) lastly, When we bill an add on code the carriers are denying as being inclusive. For example, we bill 99203-25, 11100-59, 11101, 17110, 40490. They paid the 11100 but denied the add on code as being inclusive. I always though we do not need 59 mods on add on codes?
Thanks for any feedback you can give me. It is greatly appreciated!
1) Provider performs procedure with global period. A few days later patient comes back in for another procedure (different area of the body) and the doctor codes an E&M with the procedure. Now, the doctor does not mention this issue in the previous office note which is why he is coding an E&M along with the procedure. We bill out the E&M with a 24 mod and 79 on the procedure and the carriers are denying inclusive. If we put a 25 mod on the E&M the carriers deny for being part of the global surgical package. I've been told that we are not supposed to put a 24 and a 25 on an E&M visit. Please share your thoughts/experiance with this.
2) Doctor performs MOHS (no global) and a different provider within the same practice does the complex repair who is a plastic surgeon which has a global period. When patient, again, comes back for another procedure (different area of the body) the doctor who performed the MOHS (no global) is billing an E&M with a 25 and a procedure. Carriers are denying as being part of the global surgical package. It's my understanding that it doesn't matter who the doctors are, if they are within the same practice, same TIN, the services provided in the global period will need the appropriate modifier. Can someone clairfy this for me
3) lastly, When we bill an add on code the carriers are denying as being inclusive. For example, we bill 99203-25, 11100-59, 11101, 17110, 40490. They paid the 11100 but denied the add on code as being inclusive. I always though we do not need 59 mods on add on codes?
Thanks for any feedback you can give me. It is greatly appreciated!