Wiki Please help a biller settle a dispute with surgeon!!

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arickord23

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I am having a debate with my surgeon over appropriate E&M modifiers and I need some tie breakers!!

A patient was seen today for follow up to RT shoulder pain. (No sx, no fracture, has cortisone injection in February) Today's visit we recommended MRI to RT shoulder to evaluate continued pain after PT and injection.
During this visit, he states that he stubbed his toe a few days ago.
Xrays of the RIGHT foot taken in the office today demonstrate a nondisplaced oblique fracture through the diaphysis of the proximal phalanx of the 5th toe.

We are billing the E&M for the shoulder: 99214
foot xray: 73630 &
fracture care for the toe: 28510

We are "debating" the appropriate E&M modifiers. 24? 25? Both??

Please help!!

Thanks!
Andrea
 
arickord23 said:
I am having a debate with my surgeon over appropriate E&M modifiers and I need some tie breakers!!

A patient was seen today for follow up to RT shoulder pain. (No sx, no fracture, has cortisone injection in February) Today's visit we recommended MRI to RT shoulder to evaluate continued pain after PT and injection.
During this visit, he states that he stubbed his toe a few days ago.
Xrays of the RIGHT foot taken in the office today demonstrate a nondisplaced oblique fracture through the diaphysis of the proximal phalanx of the 5th toe.

We are billing the E&M for the shoulder: 99214
foot xray: 73630 &
fracture care for the toe: 28510

We are "debating" the appropriate E&M modifiers. 24? 25? Both??

Please help!!

Thanks!
Andrea
Click to expand...

Don't destroy me for going first people !

I would use the "25" and "57" (decision for surg on foot) on the 99214
 
I agree with Plaidman, modifier 25 due to the x-ray as it has an XXX global period and a modifier 57 as the 28510 has a 90 day global and all of my carriers in 29 different states require it appended to the E&M to support it as the initial consult date.

I don't see any indication that a modifier 24 is necessary as you don't describe any global period in place for the shoulder.
 
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