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Office visit question

James Posted Sat 25th of February, 2012 15:17:09 PM

Procedure 21012 was done in the office, can I also code the office visit with E/M 99214? Would I use a modifier?

SuperCoder Answered Mon 27th of February, 2012 05:24:27 AM

If E/M is significantly separate identifiable, you need to bill this with Modifier -25 appended. If you are billing for established level IV E/M i.e. 99214, then it must meet medical necessity such as any two of the following: a detailed history, a detailed exam and decision making of moderate complexity.
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Think 99214 in any of the following situations:

•If the patient has a new complaint with a potential for significant morbidity if untreated or misdiagnosed,

•If the patient has three or more old problems,

•If the patient has a new problem that requires a prescription,

•If the patient has three stable problems that require medication refills, or one stable problem and one inadequately controlled problem that requires medication refills or adjustments.

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