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Fundamentals of Primary Care Billing: By: Abbi Crosby
Fundamentals of Primary Care Billing: By: Abbi Crosby
New Patient
● 99203
● 99204 ● 99203 / 99213 → a basic visit (1 or 2
● 99205 diagnoses)
● 99204 / 99214 → 2 + diagnoses
Established Patient ● 99205 / 99215 → sent to hospital
● 99213
● 99214
● 99215
Modifiers
● 25 ● 95 - Telemedicine
○ Attached to E & M code ● 33 - Advanced Care Planning
● 59 - Distinct Procedural Service ○ Used on wellness visits
○ EX→ EKG, screenings ● TC - Technical Component
● QW- CLIA waived ○ Only for procedures like
○ EX → UA ultrasound
● 17000 → 1 lesion
● 17003 → any additional lesions
● 11102- singular
● 11103- any additional lesion
Punch Biopsy
● 11104- singular
● 11105- any additional lesion
Wellness Visits
**pay attention to the patient's insurance because some just pay for the wellness
and no office visit but others may pay for the wellness + an office visit.
Common Codes
● Urinalysis - 87086
● Hemoglobin A1C - 83036
● Prothrombin Time -85610
● Rapid Strep - 87880
● Rapid Flu - 87804
○ We can bill the CPT Code twice b/c we are getting results for A and B.
○ Add modifiers QW & 59
Nurse Visits
Allergy Injection
● .5 cc= 2 units
● 1 cc= 4 units
Joint Injection- have to put a side under the PE. LT or RT will be used a modifier
**when 2 injections are given, modifier 59 will need to be added to 96372 to show that they
are 2 separate shots.
DOT Physicals
● A self-pay service
● $150.00