Wiki Modifier 25 and 57

[clbcarey@comcast.net]

New patient 99205 and scope 31575, with a decision for surgery following day w/90 day global. I billed 99205 57,25 & 31575. 99205 was denied ICES (modifiers) The scope was pd. What is the correct way to bill this out?
Thank you

 

[b.cobuzzi]

Clbcarey@comcast.net, you are saying that a 90 day global procedure was performed the day after the doctor performed the new patient visit and the scope. Some payers do not require a 25 modifier on new patient visit codes since there is no way that the minor procedure was pre scheduled and new patients all need to be worked up before a procedure is performed. So, if a 90 day global procedure was performed on the very next day, I would try sending in a corrected claim with 99205-57 and eliminate the 25. If the decision to perform the 90 day global procedure was made during the new patient visit, but the procedure was not performed the next day, ie, it is 2 days away, a week away, etc, that means the new patient visit is not in the global. Then try sending in a corrected claim with just 99205. If that does not pay, send in a corrected claim with 99205-25.