Can we 99213 and 99223 on same day - SG modifier on UB 04 and using 51 with DME


Can 99213 and 99223 billed together

Ans: Two E&M Can not be bill together.

Solution: If the two codes billed, then we need to Write/off for the unpaid CPT. Consultations, critical care, procedures, diagnostic services, and any other non-E/M service cannot be billed as shared visits. Which E/M services can be billed as a shared visit? Most common: New patient visits, established patient visits (follow-up visits), initial hospital visits, subsequent hospital visits, prolonged services, emergency department E/M services.

Can the SG modifier be used on a ub04

Ans :  No. You still use the SG modifier with all payors except Medicare (unless otherwise stated in your contract). Of course, if you are billing on a UB04 you shouldn't need the SG mod. But you still might use it just in case.

Note : SG — ASC facility service
For dates of service through Dec. 31, 2007, ASCs needed to use the -SG modifier on each CPT code billed on claims filed to Medicare. The changes to the Medicare program for ASCs now has Medicare requiring that, for dates of service starting Jan. 1, 2008, that ASCs are not to use the -SG modifier. This modifier may still be required by some payors on claims filed on CMS-1500 claim forms (such as Medicaid claims, if required). You should continue using –SG for payors who have previously required its use until they direct you to do otherwise. It is  not  necessary to use the -SG modifier on codes listed on claims filed on UB-04 claim forms going to other payors unless the payor requires its use. Do not use the –SG modifier on HCPCS codes billed for implants for radiology codes unless otherwise directed by the payor.

Can modifier 51 DME

Ans : No.

Note : Covered Modifier -51 designates the performance of multiple procedures, other than evaluation and management services, indicating an additional service or procedure has been performed.

Non Covered : Modifier -51 will not be accepted with evaluation and management services. If used, the claim for services will not be allowed. Response will be; “Invalid Modifier/Procedure Combination.”

Can anesthesia code a 22 modifier

Ans : No.

Note : Modifier 22 is not applicable in hospital ASC or hospital outpatient facilities in accordance with CPT modifiers approved for ambulatory surgery center (ASC) outpatient hospital use.

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