Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > E/M
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 10-22-2009, 12:26 PM
Trendale Trendale is offline
Guru
 
Join Date: Apr 2007
Posts: 230
Trendale is on a distinguished road
Default 94640 with office visit/ modifier 25?

I have recently had United HealthCare deny an office visit (99213) when it was billed with a breathing treatment (94640) stating the office visit was part of the breathing treatment service. Medicare and other insurances do not deny either when performed in the same day and no modifier is required. Are you aware of some new bundling audit coming around the corner on this? Is this something that needs to be sent for review to United?



My experience is Medicare would be the first to deny if something changed in the coding world and I think United is just creating another reason not to pay a claim.



Thanks!
Reply With Quote
  #2  
Old 10-22-2009, 12:44 PM
LLovett LLovett is offline
True Blue
 
Join Date: Apr 2007
Posts: 1,638
LLovett is on a distinguished road
Default

I ran this thru my claim scrubber and for WPSMedicare it does not require a modifier. For commercial carriers it is requiring a 25 be put on the E/M code.

I ran a report to see if we are getting denials. We are billing with the modifier 25 to our commercial carriers and without it to medicare and medicaid. Everything is getting paid that way, no denials.

I checked for 2009 and 2008. We are in Michigan.

Laura, CPC, CEMC
Reply With Quote
  #3  
Old 10-22-2009, 02:08 PM
Lisa Bledsoe Lisa Bledsoe is offline
True Blue
 
Join Date: Apr 2007
Location: Greeley, Colorado
Posts: 2,043
Lisa Bledsoe is on a distinguished road
Default

UHC follows their own coding/modifier guidelines. Use modifier -25 on the E/M. We have also found that they want modifier -59 on all procedures whether there is a CCI edit or not. Goofy.
__________________
Lisa Bledsoe, CPC, CPMA
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 03:37 PM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC