# BCBS Modifier 25?



## kgoldman CPC COC (Aug 31, 2013)

I am just wondering if anyone has experienced this.....
NP comes in w/dislocated shoulder he sx does this all the time surfing. Doc reports: 99202-25, 23650, 96372x3, (j2180?)x3. I appended Modifier 57 to the E&M and data entry took back to the doc and changed it to 25. Claim was submitted and paid.....E&M, Procedure, drugs, but not administration of injections.
I thought in order to have both E&M and Procedure with a 90 day global 57 needed to be placed. On the eob it states 93672 is a noncovered service? How are they suppose to get the meds.
I think BCBS will end up asking for a refund. Has anyone had this happen and what was the outcome of the total situation? I was shocked with the payment, granted I have not done billing in awhile.
Thanks for any feed back and was I wrong to append mod 57?

Maybe I should post this in Ortho and Modifiers.


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## OCD_coder (Aug 31, 2013)

I am curious if the 96372 bundles with the surgical code, if yes, and the drugs are *not* for lidocaine or other anesthesia to perform the procedure then they would be billable with a modifier 59.

You will need both the mod-25 and mod-57 on the E&M to support both the minor and major procedures on the same day.


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## kgoldman CPC COC (Sep 2, 2013)

*BCBS Modifier 25*

The drugs were demoral and I don't know if the administration was bundled in.  An outside billing company does all of billing, F/U, appeals etc.  Which I don't think they are.  I just kept my eye on this one because the modifier was changed.  I have seen how BCBS works when they want a refund I feel they are going to want one from this encounter.  I can't believe they paid both (e&m, procedure) with the mod 25 and the procedure has a 90 day global.

Thanks for your help!


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