Wiki Column one and two, modifier inquiry

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Recently, our office visit 99213 with modifier 25 was denied saying that 99213 is a column two code included in column one code, 97597. What would be the appropriate modifier for this situation?
Also, can anyone direct me on where to find the column one/two list?
 
Hi there,

If you've checked the payer's policy and don't see a reason for the denial, what is the rationale for unbundling the visit?

If the payer uses the National Correct Coding Initiative edits, check your Medicare administrative contractor for an NCCI tool, like the one here: https://www.novitas-solutions.com/s...TL4AykARG-DJa6jEhl2NKXECLAY92mIo5!-1030956159.

However, if the payer uses a different edit set you'll need to check with the payer.
 
I agree. Modifier is a correct code for use on a column 2 E/M service to unbundle it (assuming it's supported in documentation), and it would be allowed for this code pair under Medicare's NCCI policy. If the payer doesn't accept that, then they must either have a different policy, or else they've just made a mistake. Payers do make errors, but getting them to acknowledge that can be a challenge.
 
Is this patient coming in for routine, ongoing management of a wound with repeated billing of 97597 w/ an E/M? Who is the rendering MD/PA/PT etc? Was the ICD-10 the same pointer for both lines? There may be something else going on here.
Example: https://medicare.fcso.com/EM/0448235.asp (If the sole purpose of the visit is wound care management, only the wound care codes should be reported.)
Reading Info: https://revenuecycleadvisor.com/news-analysis/qa-cpt-coding-em-visits-wound-care
 
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