Olga Leon asked:
Can I append modifier 25 to code 99205 or 99215 if the doctor did a debridement (97597) on the initial consult?
Thank you;
Olga
Answer:
To code a high level E/M- modifier 25 with the CPT 97597 will most likely not pay if the patient was seen for the same reason the debridement took place. They usually bundle together. This is a very sensitive code to use. Check with your local MAC and get the LCD/NCD. If the visit was for one reason and the procedure for another reason; you might get paid...but know your payer guidelines on this one. [](4302073)shared excellent information on this. I am responding more as a coder and medical biller who runs into this all the time with podiatrists. The level of service it itself is too high for this minor procedure.
Can I append modifier 25 to code 99205 or 99215 if the doctor did a debridement (97597) on the initial consult?
Thank you;
Olga
Answer:
To code a high level E/M- modifier 25 with the CPT 97597 will most likely not pay if the patient was seen for the same reason the debridement took place. They usually bundle together. This is a very sensitive code to use. Check with your local MAC and get the LCD/NCD. If the visit was for one reason and the procedure for another reason; you might get paid...but know your payer guidelines on this one. [](4302073)shared excellent information on this. I am responding more as a coder and medical biller who runs into this all the time with podiatrists. The level of service it itself is too high for this minor procedure.
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