Codes that apply (usually, this Report must be given on a different day
than the X-ray Report of Findings to justify a separate billing):
1) EM Counseling: 99211-25 (5 min) = Report of Findings = service
doc-patient face to face counseling; (in Nevada, the relative value unit
is RVU = 0.59) = [Discussion with patient about one of more of "Diagnostic
Results, Impressions, Prognosis, Risks/Benefits of management,
instructions for management, and or follow-up]. The modifier -25 means that this code
is a separate service, i.e. a Report of findings. So if the DC went through
the Postural Report and then showed them the exercises, it would be
an approximate 15 minute service.
2) Depending on the time used to explain their posture and Mirror
Image exercises, there are increasing RVU amounts possible:
(a) 99212-25 (10 min) = "; (RVU = 1.03)
(b) 99213-25 (15 min) = ", (RVU = 1.42)
(c) 99214-25 (20 min)
(d) 99215-25 (25 min).
3) Code 97750 Physical performance test or measurement complete
with written Report (relative value unit = 0.77). For examples in Nevada,
from low-medium-better, one unit is $56USA; for 99213, we have $56 x 1.42 =
$79.52....and for 97750, we get $56 x 0.77 = $43.12.
Additionally, it appears to us that:
1) A DC could bill for both codes:
a. 99212 + 97750 = $57.68 + $43.12 = $100.80 OR
b. 99213 + 97750 = $79.52 + $43.12 = $122.64.
2) A DC could bill for both codes because 97750 is posture
evaluation with written report and one of the 9921-* is a face to face report of
finding.
DISCLAIMER: The above information is for reference only. No claim of reimbursement is made or implied.
Article ID: 17
Created: November 24, 2011
Last Updated: November 24, 2011
Author: Joseph Ventura
Online URL: https://posturepro.phpkb.cloud/article.php?id=17