E&M Coding Based on Time

Question:

Our surgeon saw a new patient in the office yesterday. His documentation supported reporting the E&M using time instead of based upon MDM. My question is about the time calculation. Today, he reviewed an MRI that the patient brought in this morning and he wants to add that time to his total time from yesterday, the date the patient was seen. The reportable E&M would change from 99204 to 99205 if he is able to do this. He thinks yes, since it was within 24 hours of his encounter with the patient. Is this acceptable?

Answer:

Thank you for asking. This question is more common than you may think.
When coding by time, only the time spent on the actual date of the encounter is applicable. This work the next day may not contribute to the overall total time; any records reviewed prior to the date of the encounter for efficiency purposes or preparation for the day also may not count toward total time on the actual date of service.

Modifiers on Unlisted Codes. Yes or No?

Question:

Can I use modifiers on an unlisted code? What about global period modifiers such as 58, 78 or 79? It seems reasonable to append those modifiers to the unlisted code.

Answer:

There is not a single right answer to this question. CPT said, in an old CPT Assistant, that generally modifiers are not appended to an unlisted code.

Payors have their own rules. For example, some payors will accept modifier 62 (two surgeons/co-surgery) on an unlisted code such as 64999 while other payors do not.

We would not append modifier 50 (bilateral procedure) to an unlisted code. Your base, or comparison code, should reflect modifier 50 and the associated increase in fee. The same is true for modifier 22.

We also would not append modifier 51 (multiple procedures) to an unlisted code. Let the payor take the discount.

Coding for Spine Procedures that Cross Spinal Junctions

Question:

How do you report a spinal procedure for example, arthrodesis or laminectomies when two spinal are involved. For example., both thoracic and lumbar spine?

Answer:

Report one stand-alone/primary code even when the procedure crosses spine junctional levels. Use the stand-alone code for the spine region where the majority of the procedure/levels is performed.

• Example:T11-S1 posterolateral arthrodesis (T11-T12, T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, L5-S1)
  Use 22612 (the lumbar stand-alone code, since more level were lumbar) and +22614 x 6

*This response is based on the best information available as of 08/11/22.

Angiogram Billing for All Vessels Viewed

Question:

Can we bill for all vessels mentioned if they are documented within the angiogram?

Answer:

No. You should only bill for vessels that are targeted and are medically necessary. Documentation alone doesn’t mean that procedures are always separately billable.

Use of Modifier 52

Question:

My surgeon was called into a laparoscopic operation that was already underway, to perform extensive lysis of adhesions. Does he need to use a modifier 52 because the patient was already “opened”, or can we just bill for 44180 Laparoscopic lysis of adhesions?

Answer:

You would bill for 44180 without a modifier 52, as the surgeon performed the entirety of the procedure listed.

*This response is based on the best information available as of 08/11/22.

E/M Visit During the Global Period

Question:

Can I bill an office visit in the global period if the diagnosis is different from why I did the original procedure?

Answer:

Yes, as long as the diagnosis is not for a related issue (e.g., complication from the original procedure). The documentation must be clear that the condition is unrelated to the original procedure and reflect a clear plan of treatment for the new/unrelated issue. You will then append modifier 24 (unrelated E/M in a global period) to the E/M code.

*This response is based on the best information available as of 08/11/22.