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Newborn charges for Pediatrician billing

Ray Posted Thu 29th of December, 2011 17:08:29 PM

We have been billing hospital newborn charges with two modifiers when two procedures are done on the same day. For Example: 54150 (Circumcision) mod 59 and 99462 (Subsequent Hosp visit) mod 76. Is this correct or should we only be using one modifier when billing two procedures on the same day for our newborn charges? we also use the 76 modifier if it's the circumcision and the discharge billed on the same day. we always use the 59 modifier on the circumcision and the 76 modifier on the other procedure. please e-mail me at lvillarreal@totsandtykes.com Thank you.

Lucy M. Villarreal
Tots and Tykes Pediatrics
817-652-3395 Ext: 23246

SuperCoder Answered Thu 29th of December, 2011 21:48:58 PM

99462 is an evaluation and management service not a procedure. You should append modifier 25 on 99462 or the em code and no modifier on the circumcision. Modifier 59 is to go on a procedure that is bundled per CCI edits into another code. Modifier 76 is for a repeat same procedure.

Jen Godreau, CPC, CPMA, CPEDC
Director, SuperCoder.com

SuperCoder Answered Thu 29th of December, 2011 22:19:02 PM

Sorry! Jen.
I opened the question for a long time and posted my answer lately.
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If you are billing only the codes 54150 and 99462 on that DOS, and no other service is provided on that day, then you need to take proper modifier and coding rules while billing.
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99462 is a subseqent hospital visit, so no need of billing 99462 with modifier 76.
At the same time, the global period for the cpt 54150 is zero. So, you can bill 99462-25 and 54150

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