Questions for Dr. Stern
About Your Urgent Care Center
60. I recently took a job at an Urgent Care Center and realized when we billed an E&M code with other codes such as 90772,94760,94664 99173 they will bundle. We start using modifier code 25 and we seen some payment. Is that the correct modifier code to use to get the maximum payment from payors.
Thanks for contacting us. The next extensive class on urgent care coding will be at the fall UCAOA conference 2008 in Memphis, TN. However, Practice Velocity specializes in maximizing coding for urgent care billers. We are so successful in this that our system is available on a thirty-day trial basis, and every center that has evaluated our services has found at least $9 per patient of increased revenue (most see $15-25 of increased revenue) per patient.
In answer to your question:
Yes, modifier -25 will help you get appropriate payment for many procedures that are performed during the same visit as an E/M code. In some cases, however, the procedures are already considered as bundled into the E/M code.
Pulse oxymetry CPT codes 94760 and 94761 are designated by The Centers for Medicare and Medicaid Services (CMS) as "status T" codes. Status T codes are only paid if there are no other services payable under the physician fee schedule on the same date by the same provider. Otherwise, these procedure codes are bundled into the service(s) for which payment is made. Thus, for Medicare, these codes are only eligible for reimbursement when billed as stand-alone procedures.
Under CMS guidelines, CPT code 99173 may not be reported separately if visual acuity is measured as part of a an E/M service, because the test is then diagnostic rather than screening.
