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Module 3 Discussion

module 3 discussion

Discussion Question:

Which Current Procedural Terminology (CPT) category explained in the textbook (Figure 6.1) do you or would you use most often in your current employment? Explain the category and how you do or would effectively use the category. Would you every bill from multiple categories? Explain.Discussion #2

Discussion Question:

Go to the following website: http://www.medicalbillingcptmodifiers.com/p/list-of-cpt-hcpcs-modifiers.html
Identify and explain 2 modifiers you currently use or might use at your place of employment. In your explanation, explain the reasoning behind using the modifier. For example, a surgical nurse might use extended anesthesia time due to difficult intubation or the patient took longer to wake up than usual.

SAMPLE DISCUSSION RESPONSES

Discussion 1

The Current Procedural Terminology (CPT) category I currently use in my current employment is the category I code. Category I codes is the most commonly used CPT codes in healthcare. We use the codes to describe the services and procedures that are widely performed by nurses and physicians (Centers for Medicare & Medicaid Services, 2021). Category I codes are five-digit numeric codes and are organized into sections. One of the sections is evaluation and management. In this section, the codes are used to show the evaluation and management services the patient received. The second category is anesthesia. Other categories include surgery, radiology, pathology and laboratory, and medicine. I use the category effectively by using the most specific code available.

When selecting a Category I code, it is important to choose the most specific code available that accurately describes the procedure or service performed. I also review the coding guidelines to ensure that I use the most current guidelines since they change often. Guidelines provide the most current data on how to use the codes (Centers for Medicare & Medicaid Services, 2021). I also ensure that I am up-to-date with any codes added in this category to prevent misinformation. Lastly, I also work with a coding specialist to ensure that I effectively use the category. I may benefit from working with a coding specialist to ensure accurate coding and billing when coding complex services and procedures. 

I only bill for category I coding because I do not have specialized training or certifications that allow them to perform additional procedures or services.

Reference

Centers for Medicare & Medicaid Services (2021). Medicare Claims Processing Manual: Chapter 12 – Physicians/Nonphysician Practitioners. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

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Discussion 2

We use many modifiers in my work setting. One of the modifiers we use is modifier -25. This modifier is used to show that the same physician or other qualified healthcare professional provided a significant, separately identifiable evaluation and management (E/M) service on the same day as a procedure or other service (Centers for Medicare & Medicaid Services, 2021). Healthcare professionals in my work setting use the modifier to show that the E/M service was above and beyond the usual pre-and post-procedure care, and should be billed separately (Medical Billing CPT Modifiers, n.d). For instance, if a patient requests a colonoscopy and shares new symptoms with the physician and performs a separate evaluation and management (E/M) service to address the new symptoms, in addition to the colonoscopy. The two services will be billed differently as follows;

  • Colonoscopy (CPT code 45378): $1,000
  • Evaluation and management service (CPT code 99213-25): $150

Here, the modifier has been used to show that the E/M was a different service. The modifier might ensure that the provider and the hospital are paid higher for the services. If the modifier is not available, the services will be bundled together.

The second modifier is -59. The modifier is used to show the service or procedure that was independent or distinct from other services provided on the same day (Medical Billing CPT Modifiers, n.d). The code is used to communicate that the procedure or service should be paid separately from other services that may normally be bundled together. For instance, if a patient has been provided two services such as two injections in the same position, the code is used to show the billing department that the services should be billed differently. 

References

Centers for Medicare & Medicaid Services (2021). Medicare Claims Processing Manual: Chapter 12 – Physicians/Nonphysician Practitioners. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

Medical Billing CPT Modifiers. (n.d.). List of CPT/HCPCS Modifiers. https://www.medicalbillingcptmodifiers.com/list-of-cpt-hcpcs-modifiers

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