Wiki Billing 81002 with an E&M code

[PamMasonHBA]

My billing staff have been routinely writing off denied UAs (81002). The majority of the time the code is billed with an E&M code. Should we be adding a modifier to keep the 81002 from being bundled?

 

[TiffianyEdwards]

mod ? 25 or QW

What is the denial reason? Is it being bundled? if so a 25 mod would be needed on the EM code to unbundle. Also might want to check with CLIA guidelines does the 81002 need a QW ? Is it meeting medical necessity what dx code are they billing with?


Lots of reasons it could be denied ?

 

[npricercm]

Billing 81002 with an E/M code

My billing staff have been routinely writing off denied UAs (81002). The majority of the time the code is billed with an E&M code. Should we be adding a modifier to keep the 81002 from being bundled?

These denials can also be payor specific, I would also check the insurance payor policy.

 

[codernickie]

I know for aetna insurance I have to apply a modifier 25 on the E&M code but all other insurances I do not have. It has to have a proper diagnosis attach to 81002.