Dana000
New
Medicare has been denying all of our est. patient E/M visit codes from 2013 when done in conjunction with any other service regardless of modifier 25. Is anybody else having this problem?
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Wiki Medicare Denying E/M established charges
- Thread starter Dana000
- Start date
Pam Warren
True Blue
The CCI edits state that all minor procedures (0-10 days) include the E&M visit, even for a new patient. You can add the modifier in cases of "significant and separately identifiable", but we have found that our contractor is denying them across the board.
Dana000
New
We are getting paid for new patient office visits with no problem, however, the established OV's are a different story. We had no issues last year. I wonder what's changed?
mitchellde
True Blue
the 2010 audit produced the results of an over utilization of the 25 modifier with insufficient documentation to support the use. You need to appeal all those where it was denied providing you have the documentation to support the usage.
nyyankees
True Blue
Sounds like Medicare is considering these to be guilty until proven innocent.