Device Check & Office Visit on the Same Day
Physicians can and should perform device checks and office visits on the same day. But if these services are not reported in the optimal way, denials will frequently happen. The difference between getting paid and denied frequently comes down to a modifier and a diagnosis code.
Medicare has established that visits on the same day as office-based diagnostic tests will be compensated if the visit is not the routine face-to-face time needed to perform the diagnostic test. In the device clinic, the face-to-face portion of device checks are typically provided by a device technician. If a physician sees the patient for a visit (history, exam, etc.) before or after the test, the visit should be reimbursed. While Medicare does not officially require any special diagnosis or modifier reporting, failing to jump through these two hoops frequently results in claim denial.
Modifier 25 – This modifier should be affixed to the visit code (example 99214). It tells payers that this visit is significant and separately identifiable from other services reported on the claim. Without it, payment for some visits will be bundled into the compensation for the device check.
Diagnosis Codes – When the same diagnosis code is used for a diagnostic test and an office visit, there is an increased probability of payers assuming that the visit was a component of the diagnostic test. To insulate yourself from these denials, it is beneficial to report different diagnosis codes for the visit and the device check. It may also be helpful to report the appropriate device evaluation (Z code(s)) as secondary diagnosis codes for the device check.
These codes are listed below:
Pacemaker: Z45.010 (generator) AND Z45.018 (electrodes)
Defibrillator: Z45.02 (system evaluation)
Patient visits, coronary, peripheral vascular, pacemaker/defibrillator, electrophysiology, & device clinic
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Jim Collins, CPC, CCC