Wiki Anthem-Denied Physicals

[mmcgraw131]

I have multiple Anthem claims with denied physical exams that are billed on the same day as an office visit and flu shot. They are only paying the flu shots and office visits but denying physical for payment included in another service. I have put below how we are billing these out.

99396
99214-25
90471-59
90686

This is how I normally bill these out and have never had any issues until now. Should the 25 modifier be on the physical? Any help would be appreciated.

Thanks!

 

[acooper1]

Hi there! You would want to append a 25 to the PE as well (remove 59 from 90471). PE's are E/Ms as well so if you have Imaging, Shots, Procedures on same day, you would also append 25 to the PE.

 

[acooper1]

99396-25
99213-25
90471
90686

 

[dcollazo1]

I have multiple Anthem claims with denied physical exams that are billed on the same day as an office visit and flu shot. They are only paying the flu shots and office visits but denying physical for payment included in another service. I have put below how we are billing these out.

99396
99214-25
90471-59
90686

This is how I normally bill these out and have never had any issues until now. Should the 25 modifier be on the physical? Any help would be appreciated.

Thanks!

Modifier 25 has to be on both 99396 and 99214