Wiki 99214 & 11055

[LNader]

Help please!! I have a claim which the doctor performed a level 4 exam with paring of callus. I used a modifer 25 on the E/M and a modifer XU on the paring. It is still being rejected. So, what modifers should be used, if any. Thank you in advance.

 

[danskangel313]

Help please!! I have a claim which the doctor performed a level 4 exam with paring of callus. I used a modifer 25 on the E/M and a modifer XU on the paring. It is still being rejected. So, what modifers should be used, if any. Thank you in advance.

You shouldn't need a modifier on the paring. Did you try billing the E/M with the 25 and the paring with no mod?

 

[LNader]

You shouldn't need a modifier on the paring. Did you try billing the E/M with the 25 and the paring with no mod?

Originally I did code it that way and it was denied stating it lacked information or billing error. There is nothing in the submission ie: missing information so I figured it was a coding error. I do not have the energy to tackle the dreaded phone tree unless absolutely necessary.

 

[ollielooya]

more info needed?

You shouldn't need a modifier on the paring. Did you try billing the E/M with the 25 and the paring with no mod?

Did the office visit warrant the assignment of a level four? What are the diagnoses? And what are you thoughts behind adding modifier XU? Just curious....

 

[danskangel313]

My guess is it's a DX issue.

 

[NikkiBrownell]

Medical records? reas

I am a biller and I would suggest doing an appeal with medical records that document the reason the parring was done. I agree the original coding with the 25 modifier on the office visit is what I would have done.

 

[espressoguy]

I agree with danskangel in that it is more than likely a diagnosis issue. 11055 is considered routine foot care and some insurance does not cover routine foot care. For example, Medicare only covers 11055 with specific diagnoses.