Wiki 52000 and others

[ErinPDX85]

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]

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

 

[spuja9873@gmail.com]

52000 is getting paid and 51741 is getting denied

 

[Swendt425]

Check the LCD for the 51741 if it's denying. Make sure that the diagnosis you're reporting is supported in the documentation and meets the current LCD.