Wiki 99214 billed with 76830

[bnickelwarth]

my physician is wanting me to bill for E/M visit and TVUS in office same day. I am billing 99214 along with 76830 and Medicare keeps denying the u/s, suggesting that there is not enough information and that it is included in the visit. The physician is doing the u/s and interpreting the results and advising the patient. Am I missing something?
Dx N95.0, Dx R93,89, Dx R10.0.
Any help would be appreciated

 

[csperoni]

A distinct visit and and ultrasound performed on the same day should certainly both be payable. The diagnoses would seem to not be an issue either.
You state the u/s is denied "suggesting" there is not enough information and it is included. What is the actual denial? Is it a bundled denial?
Has your MAC requested the records and then denied? If so, there may be a problem with either the documentation being insufficient, or that you did not send all the appropriate documentation.
If the denial is bundled and you have not already sent the records, you should do so with an appeal letter.
I will note: while 99214 & 76830 are NOT NCCI edits, I have had commercial carriers that will bundle without -25 on E/M and/or -59 on u/s. I have not had that problem with Medicare since it is not an NCCI edit.