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Thread Topic: MEDI-CAL BILLING
Topic Originator: RAIKO
Post Date June 14, 2006 @ 6:15 PM
MEDI-CAL BILLING


RAIKO
June 14, 2006 @ 6:15 PM Reply  |  Email Friend   |  |Print  |  Top

WHEN A PT. VISITS THE OFFICE AND A LACERATION IS PREFORMED ON THE FOOT, CAN I BILL FOR THE E/M VISIT AND THE LACERATION REPAIR? IF SO AM i USING MODIFIER -51 FOR THE REPAIR AND A DIFFERRENT MODIFIER FOR THE VISIT? OR CAN I ONLY BILL FOR ONE OR THE OTHER?

THANKS

Ro
June 15, 2006 @ 11:59 AM Reply  |  Email Friend   |  |Print  |  Top

A laceration is preformed??????

Elise
June 15, 2006 @ 3:04 PM Reply  |  Email Friend   |  |Print  |  Top

Billing the office visit depends on the documentation.  If the patient came in strictly for the laceration repair then no you cannot bill the office visit only the laceration repair.  If the documentation requirements are met for the office visit and at that time the physician thought the laceration was extensive enough to need a repair (closure) than yes you should be able to bill for both services but you would want to use the 25 modifier on the office visit to show it was a separate service from the repair.  You would not use the 51 modifier unless you did more than one repair.

raiko
June 16, 2006 @ 11:22 AM Reply  |  Email Friend   |  |Print  |  Top

excuse me?

Elise
June 16, 2006 @ 1:40 PM Reply  |  Email Friend   |  |Print  |  Top

Sorry that is the auditor in me.  
If both the office visit and laceration repair were done then you would want to use the 25 modifier on the office visit.  Ex. 99213-25, 12001
You would not want to use the 51 modifier on the repair because you did not do multiple procedures.  Whether the insurance carrier will pay for both is hard to say because they might just pay for the repair and say the office visit is bundled into the procedure but if the physician did both I would definitely bill for both services.  I hope this clarifies any confusion.



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