# Outpatient Clinic Visits



## alopiccolo (Mar 13, 2015)

I am new to the website, and just started a job where I am coding for all types of services, where as in the past I have mainly been a "professional only" coder   I was told that I can post questions here and ask where to find resources. 

So here is my first question: I have several outpatient hospital claims billed with the G0463, and another code, such as 94620, 96413, 11721, etc... The services were billed on a UB04, with bill type 131. The information that I find online says that these codes can be billed together with the appropriate modifier, which they were. My system however is picking up this edit "Hospital Outpatient - Based on NCCI. The Billed Service Code Combination is Not Payable. This Service is not Payable with Another Billed Service for the Same Date of Service" This seems wrong to me, any help is much appreciated. I know we are all busy, so TIA!!!!


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## Porter_kd (Mar 13, 2015)

My questions is, why are you doing pulmonary stress test, with chemo services and nail debridement at the same time?  These services together does not make sense.


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## alopiccolo (Mar 16, 2015)

I am sorry for the confusion, the services I listed were examples. I have several claims with the G0463, and one of the cooresponding codes I mentioned. Such as G0463 and 96413. Then another claim for G0463 and 94620. Then another claim for G0463 and 11720. Another for G0463 and 96372. They are all billed with a 25 modifier on the G0463, but my system is picking up an NCCI edit - "The Billed Service Code Combination is Not Payable. This Service is not Payable with Another Billed Service for the Same Date of Service." 

I cannot figure out why it is denying. I find that the G0463 can be billed with each of those codes separately with the 25 modifier. Am I wrong? Our system has picked up edits that were incorrect before, so that is why I am questioning this.

Thanks for your help


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## NIENAJADLY (Mar 30, 2015)

*Outpatient Facility Visit*

Alopiccolo, you would use -59 instead of -25 modifier for those scenarios if appropriate.  -25 modifier is only used on E/M codes when a procedure is done on same day and is separately identifiable.  I hope this helps.

Thank you,
Kellie


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## mitchellde (Mar 30, 2015)

The G0463 is an E&M service in the facility so the 25 modifier is appropriate.  There is nothing wrong with billing this way for the facility, however it may depend on what else is on the claim.  Was there more than one E&M in the facility on the same day?  Did the claim need a G0 condition code, did you need a 27 modifier also?  Otherwise with just E&M and a significant procedure there is nothing except the 25 modifier that s necessary.  You did not state which revenue code you were using for each line item and that can also be an issue.


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## traci.susong@gmail.com (Jun 9, 2016)

mitchellde said:


> The G0463 is an E&M service in the facility so the 25 modifier is appropriate.  There is nothing wrong with billing this way for the facility, however it may depend on what else is on the claim.  Was there more than one E&M in the facility on the same day?  Did the claim need a G0 condition code, did you need a 27 modifier also?  Otherwise with just E&M and a significant procedure there is nothing except the 25 modifier that s necessary.  You did not state which revenue code you were using for each line item and that can also be an issue.



What if I have a REV code 510, can I bill G0463 with 25 modifier?


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