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PEDIATRIC PREVENTIVE SERVICE

Salma Posted Tue 30th of August, 2016 23:45:26 PM
Hi, On preventive service doctor bills 99401,96110,99173 and S03302 along with the 99393 mod 25. Is there any modifier that we can usse so these service will not hit patienst deductible or coinsurance with private payers?
Salma Posted Tue 30th of August, 2016 23:49:02 PM
Hi, I'm an outside biller and dose not have much access to patient's charts. How do I make sure that dooctors have enough documentation to support an EM codde? What are my obligations. Thank you
SuperCoder Answered Wed 31st of August, 2016 04:55:05 AM

Greetings from SuperCoder!

The Patient Protection and Affordable Care Act made it mandatory for all healthcare insurance plans to start to cover some preventive services and immunizations as part of all benefit plans. Specified preventive services are not subject to deductibles, co-insurance, and co-pays.

Modifier 33 is applied to indicate that the preventive service is one that waives a patient's co-pay, deductible, and co-insurance. When the main reason for the visit is for preventive services, co-pays, coinsurance, or deductibles will not apply. For more information, please refer reimbursement guidelines of your payers.

For documentation of medical records, there are 3 golden rules of medical coding:

  1. Read top to bottom.
  2. Do not guess
  3. Not documented, not done.

So rule no. 2 says – do not guess. There is no way to make sure if the documentation is enough except looking at the medical records.

Please feel free to write to us if you have any query or concern.

Thanks.

Salma Posted Wed 07th of September, 2016 23:43:00 PM
Thank you so much for clarifing it. As I said we are outsid billing company and do not have access to the actual charts. How much resposibility we have as billing company? Thanks........
Salma Posted Wed 07th of September, 2016 23:48:53 PM
Is there a modifier to use for floride treatment 99188?
SuperCoder Answered Thu 08th of September, 2016 03:00:18 AM

Greetings from SuperCoder!

Please note that only one question can be answered under single thread. Since this is a separate question, please create a new thread. This question will be considered a new question.

Thanks.

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