Thanks for your input Pam, I really appreciate your trying to guide me!!!
We don't do procedures... they are mostly tests.
As we were thought in school and also my understanding is that 59 would be appropriate if you do several test or shots. For evey test or shot I use a different ICD-9 at all times, whatever the provider would order it for. I would have used the modifier 59 on my own without being told that is how they have been doing it here. I am quite sure that that is appropriate.
I am more worried about the modifier 25 (unbundling)... I will do a test run I guess...
I will not use the 25 when I will add test to the claims with the E/M and check back with the claim if it was paid that way. It would make ME feel more comfortable to know that I am not using this modifier as I knew that this could trigger an audit.
These test are not included in the sick visit and separately identifiable as necessary to do for the provider to get a dx. That is the reason I was told to use it at my new position and I thought that was the right way to do. As time went by and I did bill many tests a day that kind of made me curious that other practices would use the 25 as often as I do? Is that completely normal for a practices? We have CLIA waved tests in the office for quicker diagnosis and accessibility and we do want to get paid and bundling would not be appropriate. We only do it as we as internal medicine wanted to have these tests available to our patients so we could treat them immediately as the results are here quickly. As a coder I am expected to make sure that we would get paid for these test and follow the medical necessity guidelines. Which I do... but none of the
insurance websites would tell you if you need a modifier 25 on your E/M. Or even if I would
call the insurance companies. They NEVER tell me how it should have been done, they just tell me it was denied for CPT or ICD-9. Sometimes I feel that we as coders are in a maze and there are no maps to find the right way, wherever you want to go...
You just go by experience (hit and miss) and maybe help from other coders who have maybe using certain codes and they get paid.
I will admit that I have never used the NCCI edits and even though I was searching for some help online... I wasn't able to even locate it. I guess maybe I will reach out to some help on forums if for some reason I won't be able to get to it myself.
I am resourceful enough to seach online for whatever I need... Most of the time I find guidelines, medical necessity (ICD-9 list). Sometimes I even get help for certain senarios about coding. Unfortunately not always and not for everything.
I was wondering, how did you navigate in the "deep water" when you started coding? Did you have a mentor at work who showed you things? Or researched like myself?
I wish that our local chapter would be more beneficial to me. We are in a small town here in North Carolina and nobody has a job as a coder... maybe 3 out of 15 who are working as a coder? They don't do the same things we do so I have zero networking opportunity locally.
I am so sorry... I am just going on and on...
I just wanted to thank you for your input and also just tell you what we do and why I do what I do...
Heni
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