The patient is 2 weeks status post laryngectomy for cancer and is seen in the surgeon's office for EM service to begin chemotherapy for the next 6 weeks. Documentation supports an established visit level 99214.
Each insurance company has their own sets of rules for processing claims with modifiers. Some of the responses you may experience include:
Sometimes the patient scenario can be very complicated, requiring the coder to think through each scenario to determine applicable services and modifiers. Review the following scenario and see if you would have coded it correctly.
The patient is two weeks status post neuroplasty for carpal tunnel of the right hand and presents to his surgeon today for a new complaint of right knee swelling and pain. The patient has a history of fluid on the knee and following examination and x-ray, the physician decided it would be best to drain the fluid from the knee in the office. The procedure was performed, the patient put on antibiotics and scheduled him to return for follow-up exam in one week.
This is a case in which you would report multiple modifiers. The patient is currently in a postoperative period due to a major procedure by the same physician. The EM service today is unrelated to the surgery and during this EM service, the decision is made to perform another procedure.
Example: 99214-24, 25 and 27370-79
Be sure to assign the proper diagnoses codes to match the service performed for each service. Do not put the diagnosis for which the major surgery was performed as this is not a visit related to that major surgery.
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.
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