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.
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.