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MsMaddy

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UNITED HEALTHCARE INS SENT US REBUNDLING POLICY FOR US TO FOLLOW. IT SEEMS LIKE THERE ARE VISITS THAT THEY ARE CONSIDERING IT AS BUNDLE. EXAMP. PT COMES IN AND IS SUFFERING FROM ASTHMA AND WE GIVE THE PT A PEAK FLOW 94200, SO WE BILL IT AS:

99213
94200
DIAGNSIS 493.90

SO THE INS UNITED HEALTHCARE DOES NOT WANT TO PAY FOR PEAK FLOW 94200, THEIR SAYING ITS A BUNDLE PROCEDURE. MY QUESTION IS, CAN WE USE MODIFIER 25 IN THIS CASE. OR IS IT A BUNDLE VISIT??
THANK YOU IN ADVANCE
MSMADDY:cool:
 
I'm pretty sure they only bundled it because you didn't put the -25 modifier on the office visit. I would try re-submitting a corrected claim.

Lisi, CPC
 
It is my experience with my organization that quite a few commercial insurances include PeakFlows in the work for the E/M done that day. The same with Pulse Oxs. We end up writing them off when they get denied if we have a contract with them.
 
My question is: Is 94200 really being performed or are they just using a peak flow meter?

94200 Measures the patient's maximum breathing capacity and/or maximum voluntary ventilation (the maximum that can be inhaled and exhaled in 60 seconds) on a spirometer.

If they are just using a peak flow meter that is included in the E/M.
 
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