Medical Billing Questions

Can I bill CPT code 94760 with CPT code 99214?

Ans : No.

Note : Pulse oximetry (CPT 94760) is not allowed with any other services performed on the same day.  CPT 94760 is a status “T” code. When providing services of an E&M visit CPT 99214 and pulse oximetry CPT 94760 performed on same DOS and we cann’t (1) bill separately for each code (2) and are modifiers.

The National Correct Coding Initiative (NCCI) edits bundle the following tests when the physician performs them on the same day. Typically, to get paid for billing the codes separately, you have to use modifier -59 (Distinct procedural service). And, you can never bill pulse oximetry (such as 94760) with another payable service. To report the lab tests (85025-85027, 86001, 86003), your office must analyze the specimen, not merely send it to a lab.

99213 – 15 minutes (average)

• Expanded problem focused history. Documentation needed:
• Chief complaint
• Brief history of present illness
• Problem pertinent review of systems
• Expanded problem focused examination. Documentation needed:
• Limited examination of the affected body area or organ system and any other symptomatic or related body area(s) or organ system(s)
• Medical decision making that is of low complexity. Documentation needed (two of three below must be met or exceeded):
• Limited number of diagnoses or management options
• Limited amount and/or complexity of data to be reviewed
• Low risk of significant complications, morbidity and/or mortality

Can medical procedure codes 99393 and 99213 be billed together

Ans : Yes.

Note : A physical health (medical) provider, not a mental health provider. If you code your visit with a mental health or counseling visit you will be denied payment. You can bill medical E and M code (i.e. 99213, 99214, and 99215) using the length of the visit or the supporting elements of the visit. You must document either the length of time (and that greater than 50% of the time was spent in counseling or care coordination) or the key elements that make the diagnoses. This process also works for the way you would bill commercial health plans.

CPT codes: There are two options: (1) bill as a 99215 if you include all elements in the note. (2) bill both (a) 99393 for the health maintenance and (b) 99213 for the ADHD evaluation. A representative from Medicaid has told us they will pay in this instance. For commercial payors, you need to include the -25 modifier, but with Medicaid you do not.

ICD-9 codes: (1) V20.2 preventative care and (2) 314.0 for ADHD.