Wiki 99232 denied

[coders_rock!]

99232 - denied
92980 - paid
99291 - paid

These services were performed on the same date of service. One MD performed 99232 & 92980, and the other performed 99291. Can anyone explain why 99232 is being denied?

 

[OliviaPrice]

The E&M is bundled into the procedure. Have you ever accessed the NCCI edits? If not I would highly suggest you become familiar with them as it seems that many of your denials are due to bundling issues.

As with most bundled procedures if the E&M was significant and separately identifiable from the procedure being performed you may add modifier -25 to the E&M visit.

There are many coders that will tell you if the decision to perform the procedure was made at this visit you may append the -25 modifier, but per our Medicare carrier this is incorrect. You have to prove the visit was in fact significant and separate from the procedure.