Wiki Using modifer 25 on preventative AND office visit

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sooloo66

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Hello -

I am looking for some help with the following scenario:

A patient comes in for their physical, 99395, and also has a probelm-focused office visit, 99213. At the time of these services, immunizations are also given, 90471 and 90732. My question is: Do I need to append a modifier to BOTH the physical and the office visit in order for all lines to be paid. The insurer denied the 99395 stating it bundled into the 90471. Here is how I billed it orginally:
99395
99213-25
90471
90732

Thanks for any input. If someone knows where I can view a "rule", I'd greatly appreciate a link.
 
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Who is the payer? Typically you would put the 25 modifier on the 99213 visit. Some payers are wanting the 33 modifier on the preventative code as well.
Good Luck ;),
L Imparato, CPC, AAS, LPN
 
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Is it UHC? They do that to us all the time. We do get it paid with a 25 on both, which is technically incorrect, but seems to work for them. A physical, office visit and anything else (procedure, vaccination) makes them bundle the physical in with the office visit. The only way to stop this is to add a 25 to both. And it doesn't work with UHC Medicaid, they always will bundle a physical with the office visit. Weird payer.
 
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