Coding Corner Answer

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The proper way to code this visit is as 20610, 20610-59, 90772-GA. You could not code an E/M visit because there is no documentation of an examination being done. Because the shoulder and the elbow are both large joints, you would use a -59 modifier on the second code to notify the carrier that the injection was for a different area of the body. The Enbrel injection is not covered by Medicare, so you would need to have the patient sign an Advance Beneficiary Notice (ABN) before the service was performed. Without a signed ABN, the patient would not be liable for the charge. The GA modifier notifies Medicare that an ABN is on file.

Referred to as -X modifiers, they are designed to define specific subsets of -59 modifier

A 27-year-old, left-handed man was referred to our ultrasound clinic for left elbow pain. History The patient had been a pitcher on a Minor League Baseball team. Two years before, he developed sudden, severe medial elbow pain while pitching in a game. The pain was associated with some tingling down the left medial forearm. The…

The common causes of shoulder pain and diagnostic tests that rheumatologists need to know

Take the challenge. 1. A—Modifier -25 is defined as a significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. It is to be placed on the E/M visit only because it attests to the payer there is…

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