Wiki Modifier - Fidelis denied the 2 services

[veloso]

Hi All,
Fidelis denied the 2 services rendered by both Credentialed NP's (Psych and Internal Medicine) done on SAME DOS claiming that it needs a MODIFIER? This a Physician's Billing.

Have a safe day everyone and thanks.

IM

 

[lindaconway]

They may be looking for a PE modifier. Some of our work comp companies require it.

 

[veloso]

Hi Linda,
Sorry, what is the meaning of PE?

Ty

 

[OCD_coder]

We need to know what CPT codes were billed to determine what modifier is appropriate.

If you billed two E&M's, such as a 99213 and a 99214, a modifier 25 may be necessary on at least one of these services. But if you billed a psych code that includes an E&M inside that code, you won't be able to bill both services on the same day no matter what. A modifier will not get you paid no matter what.