Wiki Bundeled Codes Medicare

sunitabacchus

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Ocala, FL
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Hello.

We are coming across an issue where Medicare is bundling some of our claims.

Example: Patient comes in on 5-1-13 has office visit, gets a couple injections, has EKG, and gets cryo of a wart (cpt 17000). Patient comes back on 5-8-13 because they've got a cold now.

When we send out the 5/8 claim, its coming back denied because Medicare thinks it belongs with the 5/1 DOS. (Yes, we know that MOD-25 needs to be on the 5/8 claim, but we don't remember this until we get the claim back denied.)

What does your office do in this scenario if you go to bill for the DOS 5-8-13, and you don't remember that the patient was just there 7 days prior, to prevent the claim from being denied?

Thank you!
 
Modifier in post op period

I think you are applying the incorrect modifier. The modifier to apply when you are providing an E&M service for a patient in a post-op period for an UNrelated problem is 24 - not 25. If someone doesn't catch this on the front end the only thing you can do is add the 24 modifier on the back end and file a corrected claim.
 
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