Wiki 94640 & E/M code

[ldaniels]

When we give a neb, we typically bill an E/M code (99212-99214) plus the 94640. I noticed that one of our payors is bundling the two codes together but really are only paying the neb. This payor said we should be using the a modifier. Should we use a 25 modifier on the E/M or just bill the 94640 by itself? Does anyone have this problem? We use samples of albuterol so we don't not bill for that.

 

[jek521]

You should bill for both the E/M + modifier-25 and the neb treatment. Don't forget supplies (such as A7003/A7015). We also often use drug samples for treatment, but if our drug supply is used, we bill the J-code for the drug.

Jen