Wiki Humana Denials

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graceroni13

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Hello,
I was wondering if someone could help me out on this one. We keep getting denials for office visits with modifier 25 from Humana. The reasoning is: "Use of the modifier on this service or a related service, billed on the same date by the same provider, is not supported by the information on the claim or in member history." It's the same thing over and over for almost every office visit with an injection. We call and talk to them, they ask for the note then deny again. Then I write an appeal, then they stand with their decision and it gets written off for being bundled. I mean is there something I'm not saying right in my appeals? I know there are certain circumstances where we can't charge for a visit, but maybe I'm not clear on all of them... I really want to understand this so that we can stop receiving these denials.

Thank you!
 
E/M with mod 25

I would love to help you but without knowing what the codes and notes say, it would be a bit difficult. I know we bill Humana all the time and do not have that issue. If you could provide a redacted note to review it would help immensely.
 
Hi! Wondering if Graceroni13 ever got an answer to question. I'm having the same issue and I did a search in the forum but it seems yours is the only inquiry related to this topic. Could sure use someone's help as to what /if we can do something differently when billing these visits with injections.
 
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