Wiki 99397-ADDING 25 MODIFIER

[kguzikowski]

Using Modifier 25 with 99397

Provider sees patient for exam 99397. Provide also bills 69210 makes note in chart under -Objective and Assement-

Ceruminosis R Canal., -objective

Ceruminosis, right-assement​

EXCESSIVE CERUMEN IN EAR CANAL​

​

Anthem denied the 69210 as bundled. At the time service was billed 25 modifier was not included. Biller indicates adding 25 modifier to the claim will fire a claim edit for the 25 modifier. In this scenario could a corrected claim be submitted adding the 25 modifier, to justly the billing of the 69210 for payment ?

 

[Rajinder_Dhammi]

Yes, bill it like this:

99397-25 (Use any dx other than Ceruminosis)
69210-RT (Use Ceruminosis dx)

Also, not to forget if the patient is in global period, use 24 modifier as well with 99397 (again take care that the dx should be different from the dx billed for the surgery which led the patient to be in a global period, HIGHLY IMPORTANT).

NOTE: Both dx should be different, else it is going to get denied again.........LOL

Thank you,
Rajinder Singh Dhammi, CPC