Wiki coding Injections, Admin. and office visits

[robinkea]

Hey,
Can anyone give me information on billing 99203-25, 96372 and J1885. I'm being told by the office that's biling it that 96372 is being denied. These are commercial carriers that are doing this. Is there somwhere that I can find the rules for this in writing?

 

[pamtienter]

Someone should check with the insurance company on the reason behind the denial. The 25 modifier is on the E/M so it all should be paid but maybe there is another reason?

 

[Lisa Bledsoe]

I am in agreement with Pam. This should not be denied.

 

[mitchellde]

It should not be denying I agree check with the carrier on this.. CMS had a transmittal on this I believe it was july of 06 it may have been 05, where they stated it was incorrect to bundle the injection admin with the office visit when a 25 was appended to the OV.

 

[rthames052006]

Hey,
Can anyone give me information on billing 99203-25, 96372 and J1885. I'm being told by the office that's biling it that 96372 is being denied. These are commercial carriers that are doing this. Is there somwhere that I can find the rules for this in writing?

I believe this is one of those things that falls under "carrier descretion" I would start making a list of these carriers who are denying and then making phone calls to your provider reps for these insurances just to get clarification.


I have 2 insurances that I deal with on a regular basis who will not pay th e96372.

Good luck~!

 

[mmorningstarcpc]

I agree that the first thing you need to do is find out WHY it denied. It could be carrier discretion, or it could just be data entry or something on the part of the carrier.

 

[Karolina]

Definitely call them and make sure it's not a "glitch". Years ago I had that with one of my carriers, different codes though, and each time I called they had to override the system. I was told there was a glitch.

 

[ssebikari]

Be prepared to send documentation to substantiate the use of modifier 25