Wiki BCBS paid 97161-25?

[lhoang01]

hey, i notice that the new girl in my office billed 97161-25 and BCBS MA paid for that. I was confused since 97161 wasn't E/M code, my evidence was weak and not strong enough to convince my boss that we shouldnt bill mod 25. Please advise me . Thanks

 

[CodingKing]

I'm not BCBS but my claims payment system doesn't care about invalid code/modifiers combos unless they affect payment. One could argue the new PT Eval CPT codes are considered E&M (due to levels) even though they are not in the E&M section of the CPT book.

Here is what CMS has to say, its for E&M and Eye exams only

https://med.noridianmedicare.com/web/jeb/topics/modifiers/25

 

[lhoang01]

hey can you explain more or have any example for " invalid code/modifiers combos unless they affect payment" ? @codingking.