Practice Management Alert

Question: A payer denied our claim for an established patient office visitin addition to CPT 96372. We appended modifier 25 and appealed but were denied again. What are we doing wrong?Answer: If you're billing a payer that follows the Correct Coding Initiative (CCI), the edits bundle office visit codes 99212- 99215 (Office or other outpatient visit for the evaluation and management of an established patient ...) into therapeutic injection code 96372 (Therapeutic, prophylactic, or diagnosticinjection [specify substance or drug]; subcutaneous or intramuscular).Good news: If your documentation supports the office visit as significant and separately identifiable from the E/M associated with the procedure code 96372, you are allowed to override the edit with a modifier, such as modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), as you did. Be sure you append modifier 25 to the [...]