Modifier -25 and Urgent Care Codes

DAVID STERN, MD (Practice Velocity) Q. Can a patient be billed for an E/M code and an ultrasound procedure such as 93970, “Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study” during the same visit when both the scan and the E/M visit were performed by the same provider? A. If during an office visit it is determined that the ultrasound procedure needs to be performed on the same …

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S9083, Radiology, and E/M Codes

DAVID STERN, MD (Practice Velocity) Q.Can CPT code S9083 be billed with an E/M service code or would this be considered double dipping? You would not typically add CPT code S9083 to an E/M service unless instructed to do so specifically by an insurance company. CPT code S9083, “Global fee urgent care centers,” would be used in instances where the insurance company has stated that the reimbursement is based on a flat rate (global fee …

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Inhalation Treatments, OSHA Required Respiratory Questionnaires, Preventive Care Services

DAVID STERN, MD (Practice Velocity) Q.Can nebulizer treatments and instructions for use of the nebulizer inhaler be billed together? Who can perform these services in an urgent care center? A. There are two codes associated with nebulizer treatment and instruction: 94640, “Pressurized or non-pressurized inhalation treat- ment for acute airway obstruction or for sputum induc- tion for diagnostic purposes (e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermit- tent positive pressure breathing [IPPB] device”; …

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Billing for Medications, Supplies, and X-rays

DAVID STERN, MD (Practice Velocity) Q. What is the CPT code for Tetracaine Ophthalmic used in an urgent care setting? A. If you are referring to the drops used as part of the treatment in the office, then you should not charge separately for them. They are part of the E/M service. If you are providing a bottle of the solution for a patient to use at home, there are a few practical issues to …

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Fracture Care, Laceration Kits, Reimbursement for Extended Hours

DAVID STERN, MD (Practice Velocity) Q. When is it appropriate to use fracture codes without manipulation? If a patient comes in with pain in a finger after a fall and an E/M is performed, x-rays are taken to confirm a fracture, the finger is splinted and the patient is referred to an orthopedist, would that treatment constitute billing for initial care? If not, what must we do to be able to bill these? A. CPT …

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