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CPT codes should be listed in the order of work RVUs, with the highest RVUs listed first. A free Work RVU Calculator can be found at https://www.aapc.com/tools/rvu-calculator.aspx.
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There is a separate section to report E/M codes versus other CPT® codes. Be sure to place the E/M codes (99202-99499) in the E/M section and all other CPT® codes in the CPT section.
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When a service is bilateral, report modifier 50 (12345-50) instead of the CPT® code with RT and LT (12345-RT, 12345-LT).
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When a CPT code is performed unilaterally and has a bilateral indicator of 1, 2, or 3, apply modifier RT or LT, as necessary. Codes with a bilateral indicator of 0 or 9, do NOT append modifier RT or LT. The bilateral indicator can be found in the Medicare Physician Fee Schedule Look-up Tool (https://www.cms.gov/medicare/medicare-fee-for-service-payment/pfslookup). A help document is provided on this CMS page with instructions on how to use the tool.
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Use modifier 59 instead of X{EPSU} if it is not a Medicare patient. Use modifier X{E PSU} for Medicare patients.
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Report units for instances where a CPT code would be repeated multiple times to cover the documentation reporting.
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Do NOT append modifier 51 for multiple procedures.
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X-Rays:
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When an X-Ray is performed in a provider’s office, report to the global unit.
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When an X-Ray is performed in a facility, and the provider completes the formal report, report the X-Ray with modifier 26.
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When an X-Ray is performed in a facility, and the provider does not complete the formal report, do not report the X-Ray.
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Colonoscopies and conscious sedation:
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Documentation required to report conscious sedation with a colonoscopy:
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Age of the patient
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Who performed the sedation
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Total time of sedation
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Conscious sedation medication(s)
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Documentation of blood pressure, oxygen saturation, and heart rate/pulse
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Append modifier 59 to the parent code for the conscious sedation.
- EKGs: If an EKG is documented as performed on the same date of service, the EKG is reported according to the guidelines for the place of service.