52000 and others

missmeeka85

Networker
Messages
48
Location
Estacada, OR
Best answers
0
Hi there,

I am new to urology billing and am having a difficult time understanding why certain things aren't being paid. This is a common scenario at my office:

99214
52000
51798
51741

These codes are constantly denied. Typically, the 52000 will be paid and the office visit won't, and then occasionally the other 2 will be paid. I know I should add a 25 modifier to the office visit, but I am unsure about the other 3 codes.

Can someone please offer some assistance with my understanding how to bill these things out?

Thank you!
 

Machelle Freeman

Networker
Messages
77
Location
Eagan, MN
Best answers
0
They are bundling 52000 with the office visit. Even with the -25 modifier, you need to prove it was a separately identifiable problem. The 51741 and 51798 codes, should be paid without any modifiers. If you can prove you have a separately identifiable visit this is how I would bill.

52000
99214-25
51741
51798

If need be send in an appeal with the office notes.

Machelle Freeman- CPC
 
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