Wiki Medicare Bundling

[JJ]

Pt was seen in IM office for CPT 99214 & 17000 on 6-21-11. Pt then came to urgent care (same tax id) for CPT 99214 & 12001 (laceration of the elbow). MEDICARE HAS BUNDLED BOTH CODES WITH 17000 (DESTROY PREMALIGNANT LESION) DONE ON 06/21/11 AND HAS A 10 DAY GLOBAL PERIOD. I tried mod 59, which did not work. Is there a modifier that will help us get paid? Thank you for your assistance.

 

[nhenderson]

My sugestion is a mod 24 on the second 99214 and a mod 79 on the 12001

 

[JJ]

I should have mentioned it was not the same Physician that saw the patient in Urgent Care. Thanks

 

[Mojo]

Did you append modifier 25 on both E/M levels?

 

[JJ]

Yes, I think we are just going to have to eat this one.

 

[mitchellde]

No I think you should go with the 79 modifier on the second procedure. Even though these are 2 different docs they are in the same practice. So use a 24 and 25 on the second visit level and a 79 on the second procedure, see if it works.

 

[JJ]

Thank you for all the information. Debra, we are resubmitting with your suggestions. I will post an update on whether we get paid.

 

[JJ]

nhenderson, Thank you for your information, we are resubmitting with your suggestions. I will post an update. Thanks again.