Wiki Remote Physiologic Monitoring - 99457/99458

[eilujs1999]

Hopefully someone can help. I billed 99457 for the the first 20 minutes and 99458 for 20 additional minutes. But what if I need to bill for an 20 additional minutes on the same visit, do I use 99457 and 99458 x 2? Or do I use 99457, 99458, 99458 plus a modifier? I tried the 99457, 99458, 99458-25 and it paid for one of the 99458s. The other one was denied with an OA-18 denial code.

 

[jkyles]

Hi there, what's the reason for the modifier 25 on the second unit of service?

 

[sglamuzina]

You would not use a 25 Modifier and it should be 99458 x 2 ..... you may need to look into your payer guidelines if they deny.

 

[jkyles]

sglamuzina has it.

The denial is "Exact duplicate claim/service."

Keep in mind that Medicare and private payers have been trying to reduce improper use of 25 (and 59) for years. Even when it is accidental, excessive use will send up red flags, as will repeated use when it doesn't meet the requirements outlined in the full descriptor (Appendix A in the CPT manual).