▸ 90774. This code applies to one of the few procedures endocrinologists do perform: thyrotropin-releasing hormone injection for follow-up of thyroid cancer patients. The 90774 code is for an intravenous push, Dr. Orzeck said. If you buy the medication yourself, use the appropriate J code (J2725) to bill for it, he said, noting that the medication must be billed in units of 250 mcg.
▸ 90765. This code is used for an intravenous infusion, such as that used for zoledronic acid. That drug now has its own J code (J3488), said Dr. Orzeck, who is a member of AACE's socioeconomic committee. “If you do provide [Reclast], the quantity is only 1 mg for that J code,” he warned. “So if you don't bill 'times 5' for the 5 mg that you administer to the patient, you will not be paid for the whole cost; you'll only be paid at the rate of 1 mg. … This is one of the areas that we as physicians often don't get paid for doing what we do, when the money is there and we just didn't get it done.”
▸ Modifier 25. This modifier “is the one that gives us the most improvement on our billing,” he said. The CPT code book definition reads, “Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.” This would apply, for instance, when you admit a patient to the hospital after seeing them in the office to identify that the second service needed to be performed on the same day.
▸ Modifier 26. This is used when you are interpreting a stream of data or other information, and utilizing equipment you don't own or control. For example, said Dr. Orzeck, “If I dose a patient with radioactive iodine, and I want to get a [follow-up] scan, the patient goes to hospital and gets scanned on their equipment and comes back to office with the scan in hand. I'm going to use modifier 26 to show that I'm interpreting data that I did not obtain on my own but is not going to be interpreted by anyone else.”
▸ Modifier 51. This modifier is appended to a secondary procedure when multiple procedures are performed on the same day, Dr. Orzeck explained. “You will not get paid for a second procedure on the same day without putting a modifier in to show that you actually did do two separate procedures at the same time on the same patient, but they were distinct and not an extension of one procedure to another.”
▸ Modifier 91. Endocrinologists should use this code more often, according to Dr. Orzeck; it's for repeating the same test on the same patient at different times during the day. “The patient comes in and their blood sugar is 41, 58, or 396, and you say, 'I want to see what it is in 30 minutes' or an hour or whatever. You will not get paid for that repeat test unless you put the modifier on to explain that you're not doing it to verify that the test is appropriate or because the sample came from a different site, but [instead] you're doing it to look at actual information for dealing with patient management in the acute phase” of a problem, he said. With the modifier, “you will get paid for the subsequent tests at the same rate as the initial test,” he added.
▸ Bundled codes. Endocrinology does not have many “bundled” codes—which would encompass several time-consuming services usually performed as a package—but bundled codes have been proposed for certain services performed by endocrinologists. One example would be a code that comprises starting insulin, training the patient to use a meter, and instituting a new diet for a newly diagnosed type 1 diabetes patient, he said. “This is working its way through consideration, and there may be a bundled code that would incorporate the fact that the time involved is quite high in certain procedures.”