Wiki Neonalogy Moderate Sedation

[lnapoles@bellsouth.net]

Can Moderate Sedation code 99418 be billed with E/M Code 99205 with modifier 25? Insurance company is denying 99205-25 as inclusive to 99418 or would it be correct to bill 99205-59? Can someone please let me know?

 

[jettman]

Can Moderate Sedation code 99418 be billed with E/M Code 99205 with modifier 25? Insurance company is denying 99205-25 as inclusive to 99418 or would it be correct to bill 99205-59? Can someone please let me know?

For starters, modifier 59 isn't an E/M modifier so it shouldn't be used with 99205.

Is the new patient visit perfomed at the same encounter as the sedation?

To play Devil's Advocate (as personified by the Insurance Company), why would the physician who is administering the sedation (not the surgeon) also perform and document the components of a high level new patient visit?

I think the insurance company is most likely telling your sedation physician, in the form of a bundling denial, that the new patient visit is the responsibility of the physician who is actually performing the procedure.