Wiki Neb Treatment with Office Visit - I had a neb treatment

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vhammons

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I had a neb treatment denied, but they paid on the office visit. I did put modifier 25 on the office visit. The reason IA BCBS gave me was "payment is included in the allowance for another service/procedure" Any ideas? I've always had good luck getting these paid.
 
BCBS bundles the neb treatment into the E&M service. I am finding most BCBS by state follow this same policy I have attatched, I couldn't find one from Iowa specifically but since you have the denial proof, you will only be able to bill the E&M.

B. Mutually Exclusive Procedures
Mutually exclusive procedures are two or more procedures that are usually not performed on the same patient on the same date of service. Mutually exclusive rules may also include different procedure code descriptions for the same type of procedures for which the provider should be submitting only one of the procedure codes. Only the most clinically intense procedure will be allowed. Generally, an open procedure and a closed procedure in the same anatomic site are not both reimbursed. If both codes accomplish the same result, the clinically more intense procedure supersedes and the comparative code is denied as mutually exclusive.

Respiratory Treatments - Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB devise is considered mutually exclusive to an office visit. Separate reimbursement is not provided for mutually exclusive services.

https://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/bundling_guidelines.pdf
 
Neb Treatment with Office Visit

Thank you for your reply. I was confused because we gave the same patient a neb treatment in February and they did pay it.
 
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