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.

 

[OCD_coder]

I am curious if the 96372 bundles with the surgical code, if yes, and the drugs are not for lidocaine or other anesthesia to perform the procedure then they would be billable with a modifier 59.

You will need both the mod-25 and mod-57 on the E&M to support both the minor and major procedures on the same day.

 

[kgoldman CPC COC]

BCBS Modifier 25

The drugs were demoral and I don't know if the administration was bundled in. An outside billing company does all of billing, F/U, appeals etc. Which I don't think they are. I just kept my eye on this one because the modifier was changed. I have seen how BCBS works when they want a refund I feel they are going to want one from this encounter. I can't believe they paid both (e&m, procedure) with the mod 25 and the procedure has a 90 day global.

Thanks for your help!