Betsy Nicoletti, MS


January 21, 2019

Have Coding Questions? Get Coding Answers

Betsy Nicoletti, a nationally recognized coding expert, will take your coding questions via email and provide guidance to code properly to maximize reimbursement. If you have a coding question, click here to submit.

Billing Same-Day Service With an Annual Exam

Question: I'm an internist in a three-physician practice. Can I bill an office visit on the same day as an annual physical exam or Medicare wellness visit?

Answer: Yes. Both Current Procedural Terminology (CPT) and Medicare allow practitioners to bill for a problem-oriented visit on the same day as a preventive medicine service billed with CPT codes 99381-99397 or a Medicare wellness visit (G0402, G0438, G0439).

The CPT rule, which is copied below, states that treating a new or existing problem is not included in the work of a preventive medicine service and should be billed in addition to the preventive medicine code. Medicare says that both a problem-oriented visit and a wellness visit can be billed on the same day, but no part of the documentation for the wellness visit can be used to select the level of office visit. The documentation that supports the problem-oriented visit includes a description of the patient's condition in the history of the present illness and shows the assessment of the condition and treatment plan.

Physicians and other practitioners are often reluctant to bill for both services because patients complain. The patient is anticipating that there will be no out- of- pocket cost for a preventive service or a wellness visit. Over half of commercially insured patients have a high-deductible plan, and the entire cost of the office visit may be due from them directly. However, when two services are performed and documented, primary care practices can and should bill for both services.

Here is the CPT rule:

If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate Office/Outpatient code 99201-99215 should also be reported.

Modifier 25 should be added to the Office/ Outpatient code to indicate that a significant, separately identifiable evaluation and management service was provided on the same day as the preventive medicine service. The appropriate preventive medicine service is additionally reported.

Does a Separate Note Justify Separate Billing?

Question: I'm a general surgeon in a small group practice. My partner asked me to help with a colectomy on a medically complex patient. It was significantly more work than a typical surgical assist. Can we bill as co-surgeons? Would it make a difference if I dictated a note?

Answer: Unfortunately, all you can bill is for the work of a surgical assistant, whether or not you dictate a separate note.

Co-surgery is defined as two surgeons working together, performing two distinct parts of a procedure that is reported by a single CPT code.

Examples of co-surgery include 62223, when a general surgeon places a peritoneal catheter and a neurosurgeon places a V-P shunt. Or 22558, when a general surgeon performs a retroperitoneal laparotomy to expose the spine and a neurosurgeon performs an anterior spine procedure. The same code is reported by both surgeons, with modifier -62.

Medicare requires that the surgeons are different specialties, and although CPT doesn't say that, the codes that are allowed to be billed by co-surgeons typically require the surgical skills of different specialty surgeons. The Medicare Physician Fee Schedule has a status indicator that shows what surgeries can be billed as co-surgery, and colectomy is not allowed as co-surgery.

In this circumstance that you describe, you are limited to reporting a surgical assist.

Here is the CPT definition of co-surgery:

Modifier 62, Two Surgeons: When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. Each surgeon should report the co-surgery once using the same procedure code. If additional procedure(s) (including add-on procedure[s]) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added.

Note: If a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.

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