Wiki Modifier for E/M w/ Bronch?

[chelley]

Medicare has asked to recoup payment for inpatient initial visit (99222.25), but paid for the bronch (31624.59). Is the visit considered part of th bronch or should there not be a modifier on the e/m visit? Thank you for your response.

 

[philipwells]

In my experience with H&P's on the same days as a procedure, they will pay one but not the other and consider it included.

We billed for a hospitalist that would occasionally do a thoracentesis cath and even when we billed the H&P with a 25 modifier it would still deny.

 

[chelley]

thnx

Thank you for your response. Medicare has paid for E/M with procedures in the past, therefore this request was puzzling.

 

[philipwells]

Sometimes it depends on the primary diagnosis for the procedures. Usually don't want the E&M and procedure to have the same primary diagnosis as they will bundle this way.