Fundamentals of

Primary Care Billing

By: Abbi Crosby
Administrative Intern
Goal & Objectives

● Gain knowledge and experience in the fundamentals of primary care

billing to ensure payments are paid appropriately by insurance
companies.
○ Research medical billing and cpt codes for accurate coding.
○ Present my findings to the providers and my site supervisor.
○ Evaluate claims at the end of the day, correct any if needed, and drop the claims.
○ Meet with the providers at the end of the day to discuss any billing errors.
 E&M Codes

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

** if there is a telemed visit relating to COVID then we can use

modifier CS along with modifier 95
Derm Codes

Destruction of Premalignant Lesions (cryosurgery is used)

● 17000 → 1 lesion
● 17003 → any additional lesions

Tangential Biopsy of Skin (shave, skin)

● 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

● 99497- advanced care planning (modifier 33)

● 1090F- urinary incontinence
● 1100F- more than 1 fall in the past year
● 1101F- none or 1 fall in the past year

I refer to the wellness sheet for other CPT codes.

In House Labs

● 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

99211 is used if an E&M code is needed.

Allergy Injection

● 95115 → 1 allergy injection

● 95117 → 2 or more injections

If a patient brings in the medication to be injected then we only bill for

medication administration (96372).
Injections

Kenalog- have to state units

● .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

Trigger Point Injection- we do not have to state a side

96372- medication admin

**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

CPT Code- 99499

Self Pay Patients

We do have a self pay fee-schedule!

● $100- office visit

● If any other service is done during the visit then it is up to the patient to pay
for additional services before leaving
○ EX: labs, x-ray, etc.
● $120- lab panel (85026)
○ Includes TSH, CBC, VIT D, Lipid Panel, CMP, EKG, & UA
○ Make sure “practice billed” is selected when ordering labs
● Screenings are not billed
● CPT II codes are not billed
Just Remember…

● E & Z codes are considered “weaker”

● Alliant will only be billed under Dr. Beck