Wiki Podiatry...99213 with 11730

[JENNIFERNMA]

I have a question because im getting denials on 99213 with Mod 25 and 11730. Are you supposed to add a modifier 59 with the 11730??

 

[espressoguy]

No you do not need a modifier 59. What is the reason for the denial?

 

[JENNIFERNMA]

It says 99213 is an integral component of procedure performed

 

[espressoguy]

All minor procedures have an element of evaluation & management which is why insurance is saying this is bundled in spite of the modifier 25. Assuming the provider truly did provide, "significant, separately identifiable evaluation and management service," it may just be a matter of appealing with notes to show that the separate E&M was actually warranted.

 

[JENNIFERNMA]

Thank you so much! I will!

 

[dadecamp]

I believe the insurance will pay for the office visit if it has a different diagnosis code along with modifier 25