Wiki Urology consult in ER

[tnash65]

Hi! I am fairly new to urology and our provider saw a child in the ER at the request of the ER physician. I have been advised to bill 99243 with POS 22, this is a BCBS carrier, they are denying stating procedure code incidental to primary procedure. Should i be using ER codes 99283 and POS 23 or maybe even a modifier? Thanks so much!

 

[Gudisbiller]

Hi! I am fairly new to urology and our provider saw a child in the ER at the request of the ER physician. I have been advised to bill 99243 with POS 22, this is a BCBS carrier, they are denying stating procedure code incidental to primary procedure. Should i be using ER codes 99283 and POS 23 or maybe even a modifier? Thanks so much!

Hi tnash65 99283 is correct billable code using POS 23. Welcome to your new Urology group

 

[julieordway]

Did your provider perform a procedure along with the E&M visit in the ER? The denial reason you are describing looks like it pertains to a bundling issue when a procedure is billed at the same encounter of an E&M. You may need a modifier 25 or 57 on your E&M.

 

[tnash65]

Thank you somuch, this is very helpful!!!