Wiki BCBS Modifier 25

[kgoldman CPC COC]

I am just wondering if anyone has experienced this.....
NP comes in w/dislocated shoulder he sx does this all the time surfing. Doc reports: 99202-25, 23650, 96372x3, (j2180?)x3. I appended Modifier 57 to the E&M and data entry took back to the doc and changed it to 25. Claim was submitted and paid.....E&M, Procedure, drugs, but not administration of injections.
I thought in order to have both E&M and Procedure with a 90 day global 57 needed to be placed. On the eob it states 93672 is a noncovered service? How are they suppose to get the meds.
I think BCBS will end up asking for a refund. Has anyone had this happen and what was the outcome of the total situation? I was shocked with the payment, granted I have not done billing in awhile.
Thanks for any feed back and was I wrong to append mod 57?

Maybe I should post this in Ortho and Modifiers.

 

[JessH2618]

You may want to post this in Ortho like you suggested, but my experience is also that when billing an E/M with a procedure that carries a 90 day global, you would use the 57 modifier instead of the 25.

As far as the 96372 not being paid, I noticed that you typed it "96372" in one spot and then "93672" when talking about what the EOB stated. Was this just a typo in this forum or did some numbers get flipped at charge entry? If that it isn't, I would check for bundling issues. If neither one of those things are the issue, then I would try appealing the claim.

This is all just generically speaking. I do not typically code for ortho so you may get some better advice in that forum.