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OCE Edits - changes to use of CG modifier for some codes
Page 1 of 1
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?





7/29/2020 @ 5:05:00 PM
Post 2 of 10

Contributor: Tara Pfeiffer, Pender Medical Clinic

We are also concerned about the same issue

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
208-880-6076 cell

> On Jul 29, 2020, at 3:08 PM, NARHC News wrote:
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 Stuttgart Medical Clinic

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


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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, Umpqua Health RHCs

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.

Lead Billing & Coding Specialist

Professional Coding & Billing Services
3001 NW Stewart Parkway, Suite 103 | Roseburg, Oregon 97471
Phone: 541-677-6049 ext.1559 | Fax: 541-677-6140

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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 -----

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