Wiki Modifier on preventive e&m ?

[aochoa]

IM GETTING DENIALS WHEN IM BILLING AN OFFICE WITH A PREVENTIVE VISIT(EXAMPLE; 99214-25, 99396) INSURANCE SAYS I NEED MODIFIER ON PREVENTIVE VISIT, DOES ANYONE WHICH MODIFIER THEY ARE ASKING FOR?

 

[OCD_coder]

My question is are you billing any other service/procedure with this visit?

Per CPT guidelines, the mod-25 is appended to the office/outpatient code 99201 - 99215, not the preventative. So if that is the only thing you are doing, you are correct and I would call the payor and be sure it's not and error in their computer system. We were having this problem this summer until we called them directly and they fixed their edit program.

If you are billing immunizations or maybe a lab (i.e. 85025) or blood draw (36415) then you will need a mod-25 on both of your E&M codes to separate them from the procedure.

If you are billing with a procedure with a 90-day global then a mod-57 on the E&M relevant to the evaluation it applies to, probably the office CPT code. (Had to include this information as someone will ask.)

Link/limit your Dx between the two E&M codes, meaning don't use a V-code for the 992XX code when you are supposedly treating a different problem. This is highly underutilized in the industry and may prevent denials.

Hope that helps.

 

[aochoa]

Do you know if this has to do with the modifier -33?