I work for a small 150 bed community hospital. Our billing office contacted me today about a VA denial we received. We use the 3M encoder and it is setup to group following Medicare guidelines. My biller said the VA follows Medicare guidelines, BUT they are "behind" on being up to date with them. Scenario: ER patient came in, charges for E/M level 99283 and EKG 93005 posted to the account. The coder did not add a modifier 25 to the ER level (99283) charge because she did not get an edit to do so at the time she coded the account. With the new Medicare updates, the EKG now has a status indicator of N (not payable under OPPS because it packaged into the composite APC) but used to have status indicator of S and 3M would give the edit that modifier 25 could be added to the E/M level charge if documentation supported doing so. Anyway, the VA denial said they would not pay any of the claim because there was not a modifier 25 on the E/M level charge. If a denial comes to the billing office, and the billing office sends the denial to the coder to review, are we in the wrong to add the 25 modifier when the denial says it was denied because the modifier was not on the claim? Sorry this is so long, but I really need some help in understanding how this should work. Thanks in advance!