Our practice seems to be having an issue with the visual acquity screening (99173) being billed with a E/M service(99391-99394). We append modifier 25 to the E/M service and on the 99173 we have tried no modifier other than EP, we have tried a 59 modifier, and simply no modifier attached to the code at all but we still seem to be getting the same denial code "xX DENY: CMS MEDICAID NCCI UNBUNDLING". We have spoken to the payer about this issue and all they could inform us was that one of the modifiers on the 99173 was not appropriate so we have tried every combination in order to get paid. Could anyone provide some insight on this issue?
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Wiki 99173 billed with E/M
- Thread starter kayliefoster0@gmail.com
- Start date
OpenClaims
Guest
How old is the patient? I believe the CMS NCCI Edit states that 99173 is only separately reportable for patients under the age of 21, otherwise it's bundled with the CPE.
We are a pediatric clinic so the patient is under 18 years old.
OpenClaims
Guest
Then yes, 99173 is separately billable/payable due to patients age.