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Wiki Uroflows

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jcrahan13

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Masshealth is denying uroflows, 51741, and I cannot figure out why. If we are billing it with an E/M I have appended modifier 59 to it but they don't like that. Any advice is appreciated
 
Since the global for 51741 does not apply/exist, neither an associated E/M nor 51741 require a modifier when billing together.
 
If it applies add -25 to the E&M. In my experience insurances assume anything in the 5000 series of codes are surgical. With that in mind I will usually not bill the office visit with any urodynamics unless it qualifies for the -25.
 
I would agree with the above for the most part. If the patient is coming in solely for the uroflow, then you would not justify an E/M. If that patient had a regular visit with other conditions addressed besides the ones related to the uroflow, then I'd append a 25 modifier to the E/M.
 
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