venetiaroy
Guest
Odd billing scenario:
For reasons of split ownership, we are considering the following and want to assure compliance, coding accuracy, and reimbursement (or denials). Please tell me your thoughts.
Internal Med practice routinely bills trigger point injections, labs, ultrasounds, and also injections requiring an admin code (96372 or 90471, 90472). If there is a billable office visit which meets 25 modifier criteria, they add that to the claim.
In the future, ownership will change and the office visits would need to be split onto another claim form for another tax ID. The procedures would be billed on a separate claim alone or with the admin code only, but not the E&M code. Therefore, technically the office visit no longer requires the 25 modifer for billing edits, however it is still needed for NCCI compliance since without the 25 modifier, it may appear that we were unintentionally unbundling the services that would otherwise be denied. We need the 25 modifier to show that we appropriately assessed the separate and identifiable reason for billing the E&M code, over and above other codes.
This brings me to my question, what happens if we bill an E&M code with a 25 modifier alone on a claim form?
For reasons of split ownership, we are considering the following and want to assure compliance, coding accuracy, and reimbursement (or denials). Please tell me your thoughts.
Internal Med practice routinely bills trigger point injections, labs, ultrasounds, and also injections requiring an admin code (96372 or 90471, 90472). If there is a billable office visit which meets 25 modifier criteria, they add that to the claim.
In the future, ownership will change and the office visits would need to be split onto another claim form for another tax ID. The procedures would be billed on a separate claim alone or with the admin code only, but not the E&M code. Therefore, technically the office visit no longer requires the 25 modifer for billing edits, however it is still needed for NCCI compliance since without the 25 modifier, it may appear that we were unintentionally unbundling the services that would otherwise be denied. We need the 25 modifier to show that we appropriately assessed the separate and identifiable reason for billing the E&M code, over and above other codes.
This brings me to my question, what happens if we bill an E&M code with a 25 modifier alone on a claim form?