Mary Posted Wed 25th of July, 2012 14:44:01 PM
MY MD WANTS ME TO BILL A 99386 ALONG WITH AN E/M CODE FOR WHICH I WILL PUT A MODIFIER OF 25. WHAT DO I USE AS THE PREVENTIVE DIAGNOSIS V70.0 OR THE 250.00 DIAGNOSIS WHICH I WAS GOING TO USE WITH THE E/M CODE. ALSO WE ARE HAVING A DEBATE HERE AT THE OFFICE. WE ARE NOT ON ANY OF THE MANAGED CARE MEDICADE PRODUCTS IN OHIO. THE MANAGED CARE WILL NOT PAY FOR THE UPPER ENDOSCOPY OR COLONOSCOPY IF DONE IN THE AMBULATORY DEPT BUT THEY WILL PAY FOR THE EMERGENCY DEPARTMENT CONSULT. DR WANTS ME TO BILL THE PROCEDURE AS IF IN THE EMERGENCY ROOM FOR WHICH I REFUSE AS HE TAKES THE PATIENT TO THE AMBULATORY DEPARTMENT TO DO THE PROCEDURE AND ALSO DISCHARGES THE PATIENT FROM THE AMBULATORY DEPT AND NOT FROM ER. AM I WRONG FOR REFUSING TO DO THIS? THANK YOU FOR YOUR CONSIDERATION TO THESE QUESTIONS.
SuperCoder Answered Thu 26th of July, 2012 06:51:38 AM
For your first question, you should use V70.0 to the preventive medicine service code 99386.
For your second question, if managed care won’t pay the upper endoscopy or colonoscopy done in the outpatient ASC, then your point is right for refusing to the doctor because the procedure is done in the ASC, patient is discharged from ASC, and managed care won’t pay for px done in ASC, no need to bill. If the procedure would have done in the ED, then doctor is right in his/her point and you should bill for this. It does not mean that to get only for reimbursement, you are billing wrongly for colonoscopy by ED POS, medical necessity won't support.