Forum - Questions & Answers

May 12th, 2015 - shilliker 1 

MD sees patient and nurse does 30 minute teaching.

I billed 99213-25 and 98960-59. was denied on the 98960-59 as bundled and considered components of the same procedure. code 98960 is for nonphysician teaching. Should I have NOT used any modifiers?

Thank you....

May 13th, 2015 - Darlathecoder 1 

re: MD sees patient and nurse does 30 minute teaching.

Is this patient a Medicare patient? If so, code 98960 is on statutory exclusion list and not covered under any Medicare outpatient benefit. Please contact your specific MAC (Medicare Administrative Contractor) for your area concerning this.

If it is not, then I think this would probably be denied because code 99213 is submitted (physician E & M) and code 98960 (non-physician education/teaching) on the same bill. I would rebill under two separate bills as long as documentation supports for medical necessity in addition to what the physician already addressed with the patient. Also, make sure in the documentation that the education that was provided was under the physician plan of care overseeing the non-physician practitioner. As this would be an incident-to service under the physician.
Something else to consider...If it is billed on the same bill using the same diagnosis and there is no distinction for other conditions to support the additional education for another separate chronic condition, then this would not be covered because this is not medically necessary to bill for additional education/training by a non-physician practitioner when on the same day the physician already addressed the patient for the condition during a separate visit.

May 13th, 2015 - shilliker 1 

re: MD sees patient and nurse does 30 minute teaching.

This was not a Medicare patient. I do understand your explanation and I thank you very much for responding to me.

Sue



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