CPT and Modifiers
This office visit code is used for a new patient visit which requires a medically appropriate history and/or examination and a high level of medical decision-making. The time code for this CPT code is between 60 to 74 minutes.
What is 99205
When your note advises you will follow up on an account (encounter) because you left a voicemail, were you supposed to receive a fax, etc.…This is the timeframe your are required to follow up within.
What is 5 business days
This two-letter abbreviation attached to a denial code, gives you the ability to bill the patient.
What is PR
Under this section of the chart note, you can usually locate the doctor's plan of treatment and previous treatments.
What is the Assessment/Plan section
This modifier is used when an office visit was performed on the same date as a procedure or service and by the same physician, but the patient's condition required a significant, separately identifiable office visit.
What is Modifier 25
According to the COB and insurance terminated procedure, you are to reach out the patient first by phone, then by letter. If you submitted a letter to the patient, you must also leave notes in these 2 locations.
What is Nextgen Alert and next appointment
This set percentage applied to patient responsibility is usually only applied to procedures & medications, but can also apply to office visits.
What is co-insurance
This type of pain starts in one section of the body and goes down to another section of the body. For example, Low back to Foot
What is Radicular Pain or Radiculopathy
CPT code 64636 is commonly used to represent this type of surgery and levels.
What is the 2nd and additional levels of an Lumbar RFA
According to the newest attendance policy, when you are requesting PTO for 3 consecutive days, you are required to give this amount of business days of a notice.
What is 5 business days
This type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the insurance. It generally won't cover out-of-network care except in an emergency.
What is a HMO Policy
What is an Addendumn
This modifier is commonly used when multiple procedures, other than E/M services, are performed at the same session by the same provider, the primary procedure or service may be reported as listed.
What is modifier 51
According to the PRC and anesthesia workflow, addressing hold times, this is the required amount of time you must hold before disconnecting a payer phone call.
What is a trick question, There is no time limit
These codes are used to provide additional explanation for an adjustment already described by a CARC or to convey information about remittance processing
What is a Remark Code
In relation to UDS, this "color" or "risk category" patient should be tested, at most, every 1-3 times every 6 months due to questionable behaviors or findings, and may have a history of inappropriate findings on toxicology testing.
What is a "Yellow" Patient
This modifier is commonly used for Botox (J0585) to represent the drug amount discarded/not administered to any patient.
What is modifier JW
If you believe that we were short paid on a claim, you have this resource available to you for reference to determine the correct insurance allowable.
What is the Contract grids/spreadsheet.
Along with 2nd Level Unlisted Appeals, these three common denial codes can be forwarded to the appeal team for review.
What is 50, 55, 56
The pain scale used by Surgery Partners and a majority of insurance companies in their LCD, consists of how many numerical digits (values). WE DO NOT WANT THE RANGE
What is 11 digits. The Numeric Pain Intensity Scale is based on 0 (no pain) to 10 (very severe).