e/m with modifier 25

  1. N

    Wiki Unrelated E/M with procedure

    Hi, general question... Is it appropriate to bill an E/M -25 when its unrelated to the primary procedure on every visit? It's not bundled due to both codes being unrelated. For example, patient comes in for debridement 11042 on right ankle, but provider treats edema in another area which is new...
  2. N

    Wiki Bundled Office Visit w/ -25

    We have been getting denials recently from Humana when billing 99214-25 (I70.233, F17.218, I89.0) 11042 (L97.312, L97.212, T81.31XA) Dx are different for each code. Only thing I can think of is the i70.233 and L97 codes both address the 'right leg' .. BUT we have been getting paid before with...
  3. baroquecoder

    Wiki Preventative Visit and E/M

    Listed in the chief complaint is "cough and wellness check" there is an HPI for the cough and an Exam and ROS. There is a brief "wellness HPI" and mention of vaccines and nutritional guidance my question is does this qualify as a 99392 and 99214 if the patient is presenting with a problem...
  4. E

    Wiki 20611 with level 4 E/M?!?!?

    Hi All, I really need some help with this one. :confused:I have been in the medical field for 10+ years but am newly certified in coding, so I would like to come at this problem with as much data and references as I can to support my perspective. Our Sports Med guy keeps billing 20610/20611...
  5. J

    Wiki PT/INR and E/M with modifier 25 in Long term care

    It has been my understanding that billing an PT (85610) is only for the PT itself and not for the adjustment of the dosage of the medication. Since I work in long term care I have the question on if a low level E/M visit (99307) can be billed with a 25 modifier with a (85610) if an adjustment...