Wiki Massive Medicare Rejections from Clearing House,PLEASE HELP!

[adascoli87]

So i am still fairly new with orthopaedic coding, but i have a mass load of claims being rejected for patients coming in with an E&M visit and having a 20600 procedure done, is there a modifier that goes with the 20600? There is also a J0702 and a J2001 with it on the claim as well.


Please please help, my manager isn't helping.

 

[laauserc1]

are you appending a modifier 25 on the E/M service? also, is there enough proof to show that the E/M is billable separately from the injection procedure?

 

[teresabug]

Helpful pointer for you: if the injection was "pre-planned", only the 206XX can be billed. These codes changed this year 1-1-15 (flouro vs no flouro). If there is separate and identifiable documentation that supports the dr having to do a ROS and PE on the affected body area, and based on the complexity and amount, you can bill an E/M with 25 modifier. 25's ONLY go on E/M codes, no other code.