Wiki 99213, 97032, & 97035

[LDWICK24]

What modifiers should be applied to these CPT codes on a claim? Only the modifier 25 has been applied to the 99213 and this CPT paid, but the 97032 & 97035 have denied with the following explanation: CO4 "The procedure code is inconsistent with the modifier use OR a required modifier is missing.
How should this be billed?

 

[CodingKing]

Medicare, Medicaid, Commercial? What specialty and payer? Could be mod 59 to show they are significant and separate from the E&M. Some payers may want a modifier to show if the modalities are under a PT, OT plan of care.

for instance

[h=2]Therapy code modifiers[/h]

• GN: Indicates services delivered under an outpatient speech-language pathology plan of care
• GO: Indicates services delivered under an outpatient occupational therapy plan of care
• GP: Indicates services delivered under an outpatient physical therapy plan of care

 

[LDWICK24]

codingking

this is for Medicare and the setting is pain clinic, performed by MD