cbutsko
Guest
I am a collector for a large multi-specialty practice in Oklahoma. One of our insurances has long since stopped reimbursing us for both the E/M code and the osteo manipulation code when performed at the same visit by a provider whose specialty is osteomedicine, regardless of dx codes used and a modifier 25 appended to the E/M code. We've tried resubmitting the claims with medical records to appeal the denial of the E/M-25 code without success. It is always denied as incidental, even when the E/M-25 code is for a dx like....chest pain or diabetes and the OM tx code was for....say, low back pain.
Interestingly enough, an E/M-25 with an OM tx will both be paid when submitted w/medical records if the provider is a Family Practice, OB, or other specialty. It is only the Osteomedicine providers who are consistently denied as incidental.
Anyway, my question is this. If our osteomed provider renders services that are primarily E/M based/focused, but also does an om tx, would it be acceptable coding to either not charge for the om tx at all, or charge it at 0.00 and charge for just the E/M code? I'm pretty sure that even if we post the OM tx at 0.00, we're still going to have to append a 25 to the E/M code, which is always then denied as incidental even with medical records. However, in my mind we "have to charge for the services documented" and so we would be required to post both codes?
I think I may be confusing myself at this point. Any input/feedback would be greatly appreciated!
Thanks,
Cate
Interestingly enough, an E/M-25 with an OM tx will both be paid when submitted w/medical records if the provider is a Family Practice, OB, or other specialty. It is only the Osteomedicine providers who are consistently denied as incidental.
Anyway, my question is this. If our osteomed provider renders services that are primarily E/M based/focused, but also does an om tx, would it be acceptable coding to either not charge for the om tx at all, or charge it at 0.00 and charge for just the E/M code? I'm pretty sure that even if we post the OM tx at 0.00, we're still going to have to append a 25 to the E/M code, which is always then denied as incidental even with medical records. However, in my mind we "have to charge for the services documented" and so we would be required to post both codes?
I think I may be confusing myself at this point. Any input/feedback would be greatly appreciated!
Thanks,
Cate