Wiki Insurance help ??

[MsMaddy]

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united healthcare ins sent us rebundling policy for us to follow. It seems like there are visits that they are considering it as bundle. Examp. Pt comes in and is suffering from asthma and we give the pt a peak flow 94200, so we bill it as:

99213
94200
diagnsis 493.90

so the ins united healthcare does not want to pay for peak flow 94200, their saying its a bundle procedure. My question is, can we use modifier 25 in this case. Or is it a bundle visit??
Thank you in advance
msmaddy

 

[abyrne]

United Healthcares rebundling policy does allow for the use of certain modifiers to be used to identify separate or unusual services. I would use the 25 modifier for the 99213 as this is a separately identifiable service.

 

[lch]

I agree. I would use the 25 modifier on the OV as well.