Billing 99203 and 11721

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Hello, I' looking for some good podiatry coding/guideline books..does anyone have any in mind? I was also looking for information on billing 99203 and 11721; keep getting conflicting information. Can I bill those together with modifier 25...or is it just 11721 w/ ov included......HELP

 

You better have a real good diagnosis aside from 110.1 to bill the 99203 and hit at least 10 bullets in your exam to justify the "3" level billing. BTW....make sure you bill 729.5 with 110.1 and you better justify pain on ambulation in your notes, or you'll be paying a lot of $$ back someday soon.

Dr. Gary Docks
gwdocks@aol.com

 

The modifier 25 should not be necessary as it is being used with a new visit/E&M code. That being said, not all third party payors process claims the same. The reason you are seeing conflicting information is because billing experience has variability based on payor and region. Practitioners are "under the gun" to bill properly but third party payors have a lot of latitude in how they manage claims. One must study the EOBs carefully, payor by payor to look for patterns and and internal rules payors use. If a particular payor in your area insists on the addition of the modifier 25 to a new patient visit, then you must use it.

Ed

 

Welcome RAEMedical, you almost missed the a welcome as you skipped the Introductions. So here it is) Good to see you are jumping straight in.

Good Luck with your billing

Cheers