--
Douglas Krell MD
Date: Fri, 9 May 2008 16:54:20 -0500
From: RModugno@aol.com
To: ob-gyn-l@mail.obgyn.net
Subject: Re: Billing question
Not having my book handy there is a "decision to do surgery modifier" and
in the example quoted by Hank, then you could bill for both but as has been
said- good luck on getting paid.
Robert Modugno MD MBA FACOG
Sylva, NC
In a message dated 5/6/2008 10:34:41 P.M. Eastern Daylight Time,
henrygregor@yahoo.com writes:
Modifier -25 (Sigificant,separatelly identifiable E/M Service by the same
physician n the Same Day of the Procedure of Other Service). For
example, your scenario, or, a patient sees her physcian for vulvar pain and a
Bartholin's abscess is diagnosed. If the physician performs an I&D,
document the evaluation and diagnosis process separately, generally by
creating a standard evaluation and diagnosis documentation note, followed by a
separate procedure note. Then report, using the E/M code with a -25
modifier.
Be prepared to do persistent battle with the insuror. Some will
cooperate, most won't. (I guess they depend on most providers and their
billing staff to roll over, and move on to something else, like
playing the float on their delayed payments.)
Keep a careful data base of those who do, those who don't...eventually,
you can spare yourself the agony of wasting time on those carriers who won't
honor the modifier. I have found most patients are sympathetic to the analogy
that if you go the supermarket and buy eggs and butter its reasonable for the
store manager to want to be paid for both products and not just for the eggs.
I have found most patients will come back on another day to have
the procedure done, though, of course, for a symptomatic issue like the
Bartholin's cyst, that may be too burdensome and you and the patient will
probably want to do what needs doing then and there.Keep a handy printed
reference to give the patient to send to her state insurance commissioner for
consumer complaint if her carrier fails payment and the burden falls upon
her.
"Garry E. Siegel, M.D."
<garrys@mindspring.com> wrote:
If
during the course of your evaluation, you determine the need for
a
procedure (an endometrial biopsy comes to mind), then you can bill
the
E/M AND the procedure, with a modifier, I think. Lots of
luck
collecting on it, however.
That said, if someone came in for
contraceptive counseling, and you
decided to put in an IUD, I bet that
you could code it similarly with
the best of luck
collecting.
Garry
At Tue, 6 May 2008, Lynn Montgomery
wrote:
>
>Listers,
>
>I would like opinions
regarding a billing question; when a patient
>presents for an office
visit for an IUD insertion or colposcopy for
>example, is one allowed
to bill an office visit in addition to the
>actual procedure being
performed (i.e. 99203 for office visit and 58300
>for IUD insertion).
I have gotten different answers from various
>coders, including
ACOG!
>
>Lynn
>
>--
>Lynn D. Montgomery,
M.D.
>
>Obstetrics & Gynecology, Maternal-Fetal
Medicine
>
>The Birth Center/Rocky Mountain Women's
Health
>
>1211 S. Reserve St.
>
>Missoula, Montana,
59801
>
>406-549-0978
>
>fax
406-549-0987
>
>e-mail:
apgar10@thebirthcentermt.com
>
--
Garry E. Siegel,
M.D.
Private Practice
Roswell, GA
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