Modifiers such as Modifier 76, Modifier 25, 26, 51, 57 & 59. All Modifiers in Medical Billing are examples of CPT modifiers used with procedure codes.
The use of the 51 modifier in an incorrect situation will cause the related claim line to either reject or deny. Please note the 51 modifier is not required to report multiple surgeries. The use of modifier 51 for billing purposes by providers is discouraged and can adversely affect payment ...
· Modifier –25 applies only to E/M service codes and then only when an E/M service was provided on the same date as a diagnostic medical/surgical and/or therapeutic medical/surgical procedure(s). In other words, modifier –25 does not apply when no diagnostic medical/surgical and/or th...
The Initial Preventive Physical Examination (IPPE) is also known as the ‘Welcome to Medicare Preventive Visit.’ The goals of the IPPE are health promotion and disease prevention and detection. This document explains the components included in the IPPE. You must provide, or provide and refer, ...
Column 15 – The name and billing address of the primary insurer identified in column 14. NOTE: Once a credit balance is reported on the CMS-838, it is not to be reported on a subsequent period report. Payment of Amounts Owed Medicare ...
99296 and 99298 in the Neonatal Intensive Care Services. Changed the word from “incidental” to “mutually exclusive” in the Transvaginal Ultrasound section. Removed the Maldistribution of Inspired Gas, Chlamydia Testing by Direct or Amplified Probe Technique, Fluoroscopic Guidance and Voiding Pressure...
the service must be consistent with the diagnosis and treatment of the condition; be in accordance with standards of good health care practice; and not be for the convenience of the patient or provider. The following procedures/equipment would be subject to medical necessity and utilization review...
Billing scenario A patient who is being followed by her Ophthalmologist during the post-op of cataract surgery comes in for an additional visit because she has developed conjunctivitis. The conjunctivitis is unrelated to the cataract surgery and necessitated an additional visit over and above her regu...
(The same RVUs have been assigned to codes G0105 and G0121 as those assigned to CPT code 45378.) If during the course of the screening colonoscopy, a lesion or growth is detected which results in a biopsy or removal of the growth, the appropriate procedure classified as a colonoscopy ...