tci E/M Coding Alert - 2014 Issue 6

Reader Question: Use 99499 When a Service Doesn't Reflect a Code Description

Question: Can I use modifier 52 on 99201 if my provider only captures history and MDM for an office visit? Oregon Subscriber Answer: In the rare circumstance when your physician (or NPP) provides a service that does not reflect a CPT® code description, you must report the service as an unlisted service with 99499 (Unlisted evaluation and management service). A description of the service provided in the form of the provider’s notes must accompany the claim. The payer has the discretion to value the service when it does not meet the full terms of a CPT® code description...

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