Codes 93018 & 93016

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104
Location
Hurricane, WV
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Our physicians normally do a consult, admit, office visit etc on the same date of service as a nuclear stress test. When this happens we always append modifer 25 to the office visit or admit. However recently we have been getting paid for the admit/office visit and the nuclear (78452). We have been getting denials from Medicare on the codes 93018 & 93016. According to CCI edits we can append modifer 59 to those codes. But I feel as though putting a 25 & 59 is overuse of the modifiers. Has anyone else been getting denied for these 2 codes by Medicare? Does anyone have any suggestions or ideas as to why these have been denied? And what we can do to change it?

Thanks for the help. Much appreciated.
 

Jess1125

Expert
Messages
403
Location
Green Bay
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If I have a patient who has an admit/consult or visit in the office the same day as 93016/93018 I would put a -25 modifier on the E/M code per CCI edits but that is it and I haven't been having any issues.

Jessica CPC, CCC
 
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