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Brush up on modifier 24 guidelines to ensure payment for postsurgical unrelated E/M services. Standard postoperative care, including related evaluation and management (E/M), is not separately reportable, but an unrelated E/M service during the postsurgical period may be. To alert the payer that an E/M service provided during the global period is not related to […]
The post Modifier 24: Determine How Your Payer Defines “Unrelated” appeared first on AAPC Knowledge Center.
Examples:
1) Blue Cross Blue Shield bundles the G0101 and Q0091 with a preventative exam 99381-99387, would you code the G0101 and Q0091 on the claim or not code it due to the bundling edit? Or do you code it and make adjustments on the billing side?
2) When a patient is seen and has a split bill (preventative/sick visit) Blue Cross Blue Shield does not allow both codes, would you code both or would you remove the CPT that has the least medical necessity for the visit documentation.
My boss says that code 99218 has to be added multiple times to get reimbursement (added once for every 30 min that the patient is observed) So let’s say the patient was observed for 6 hours, according to her it must be added 12x. Makes no sense to me. Shouldn’t the 99218 be coded just once in this case?
This is for facility coding. I have tried to show her the CPT description that says ‘per day’ but she says that’s for physician billing. Do you guys know of any guideline that I could show her in regards to this? PLEASE advise!! Thanks.
I am looking for information or experience in a situation where Medicare is the 2ndary payer who over pays what they are billed as 2ndary and leaves a co-ins. Is this correctly adjudicated or can they not leave a pt resp greater than what the primary left for Medicare initially.
Thank you,
Jessie
Thank you!
V. Richmond, MHA, CPPM