Dharti87
New
Cpt 99177 comes back denied when submitting with an office visit, even when submitted with a 59 mod. Any suggestions on how to get this code paid?
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Wiki 99177 and office visit
- Thread starter Dharti87
- Start date
mitchellde
True Blue
Assuming the documentation supports it, have you attached the 25modifier to the office level?
Dharti87
New
yes and filled appeals
clayjagod1
Guest
CPT manual states that it is not to be billed with an office visit (I assume the office visit you're referring to is 92002-92014). The P2P Edits on CMS' website states it is bundled with the exam also. Commercial payers may have age restrictions on the code as well. It would be helpful to know which carrier you are billing and what are the adjustment codes you are receiving on the remit.
Dharti87
New
We bill it out not with office visits I'm sorry I meant with well visits 99391-9939*, and It mostly BCBS that denies it with codes CO4, N519 (if submitted with imms and such we have to add modifier 59 to distinct it)
Cynthia Hughes
Expert
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99177
Check the specific payers policy for preventive services. Some allow separate payment for automated vision screening for children up to 5-years-old and some do not. The reimbursement policies are often posted on the payer's site.
Cindy
Check the specific payers policy for preventive services. Some allow separate payment for automated vision screening for children up to 5-years-old and some do not. The reimbursement policies are often posted on the payer's site.
Cindy
steinbrc
New
How old is the patient? I found on the GoCheck Kids site that adding a modifier 33 for ages 3-5 only and to add modifier 59 with a wellness visit, both modifiers if between 3-5 years old. Our office just started using this so in the early stages still...