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| 7/29/2020 @ 3:36:00 PM
Post 1 of 10
Contributor: Ashley Allers, Van Diest Family Health Clinic
Has anyone had issues with some of the newer OCE edits that went into place regarding some codes that are now excluded from using CG modifier? In particular the following codes: 11750, 11765, 12001, 20600, 20604, 69200 We have providers in our RHC that perform these procedures quite frequently, and they do not always have an E/M associated. Does anyone have insight on why these have been excluded from use of CG modifier and what you are doing instead? Thanks,
7/29/2020 @ 5:05:00 PM
Post 2 of 10
7/29/2020 @ 5:15:00 PM
Post 3 of 10
Contributor: Dana Gies, Associates in Family Practice RHCs
You only use the CG on the visit.
Dana T Gies, CEO Associates in Family Practice, P.A 208-934-5900 208-880-6076 cell > On Jul 29, 2020, at 3:08 PM, NARHC News > >  > 7/29/2020 @ 6:28:00 PM
Post 4 of 10
Contributor: Ashley Allers, Van Diest Family Health Clinic
Our issue is that we have patients who come in and don't always have the E/M office visit but rather just the procedure by itself. It is still a physician or provider performing the procedure and still face to face, but they may not document everything they would to qualify for an E/M because they are only performing the procedure.
7/30/2020 @ 8:46:00 AM
Post 5 of 10
Contributor: Rosemary King, Love Memorial Clinic
Well, without the visit charge, the claim will get "hung up' in the FISS system (Novitas). Many times, we'll charge the visit & procedure, just decrease the price to match the amount with CG & 25 modifiers. That works sometime....if not, we have to eventually change the procedure to just a visit code, otherwise, it won't get paid at all
----- Original Message ----- 7/30/2020 @ 8:50:00 AM
Post 6 of 10
Contributor: Anna Bennett, Baptist Health RHCs
I am on PTO. If you need assistance, please contact Jon Watson at 501-202-3748 or Monica Kramolis at 501-206-4613. -- Thank you! Anna Bennett, CRHCP Clinic Manager BH HS RHC Network 501-887-3510 o 501-691-3766 c 501-887-3515 f  ------------------------------  IMPORTANT DISCLAIMER NOTICE  -----------------------------  The information, both of the message and any attachments, contained in this message is intended only for the use of the individual or entity to which it is addressed. This message may contain information that is privileged, confidential, and exempt from disclosure under applicable law.  If the reader of this message is not the intended recipient or an agent responsible for delivering it to an intended recipient, or has received this message in error, you are hereby notified that we do not consent to any reading, dissemination, distribution or copying of this message and any such actions are strictly prohibited. If you have received this message in error, please notify the sender immediately and destroy the transmitted information.
7/30/2020 @ 8:53:00 AM
Post 7 of 10
Contributor: Rosemary King, Love Memorial Clinic
CG can only be used on E/M visits....we tend to bill a visit with the procedure & adjust the total fee to that of the procedure. Sometimes it works, sometimes not. If does not, we eventually just change to E/M for the price of the procedure....only way it will get paid sometimes
----- Original Message ----- 7/30/2020 @ 9:49:00 AM
Post 8 of 10
Contributor: Cassie Beesley, Springfield Clinic - Hillsboro East
CG is billable on the stand alone codes by themselves. It is not only billable on an E/M. If we only have a procedure the CG goes on that and it is paid at the all-inclusive rate. The only one we have had trouble with lately is the ear wash 69210 by itself. Palmetto is rejecting it.
[cid:image003.png@01D4EA20.04F19020] Cassie Beesley, CRHCP Rural Health Clinic Manager Springfield Clinic Phone 217.528.7541 x44801 7/30/2020 @ 9:49:00 AM
Post 9 of 10
Contributor: Jessie Siegel,
You should report the CG modifier on the line for the primary reason for the medically necessary face-to-face visit. This is for medical and/or mental health HCPCS codes.
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/RHC-Reporting-FAQs.pdf Jessie R Siegel CPC, CPMA, CDEO, CRHCP, RH-CBS Lead Billing & Coding Specialist Professional Coding & Billing Services 3001 NW Stewart Parkway, Suite 103 | Roseburg, Oregon 97471 Email: jsiegel@pcbsoregon.com Phone: 541-677-6049 ext.1559 | Fax: 541-677-6140 CONFIDENTIAL INFORMATION This communication may contain confidential information, including health information protected by federal and state laws. If you received this communication in error, please delete the information and notify us that we have an incorrect address. 7/30/2020 @ 2:49:00 PM
Post 10 of 10
Contributor: Rosemary King, Love Memorial Clinic
This has been our experience: when we've billed to Novitas for just a procedure, it won't pass the edits & "hangs up" in the FISS. It also has been our experience that it will not be paid until this is changed to one of the previous two scenarios I mentioned...
----- Original Message ----- |
