Wiki Cpt/Modifier question

[BRETT]

I recently billed a 99212 (physician visit) and a 90772 (injection given by the nurse) on the same date of service. The 90772 paid, however, the 99212 denied stating it was inclusive to the 90772. When I spoke with the insurance, I was told I could rebill with a modifier and this would possibly pay. Which modifier would you suggest? and what cpt would you apply it too? Thanks for all suggestions!

 

[dmaec]

you'd need a .25 modifier on the office visit - IF, you actually do have a "significant, separately identifiable Evaluation and Management Service provided by the same physician on the same day of the procedure or other service" (in your case the injection)... that being said;
we typically do not charge out the 90772 on commercial insurances when there is an E/M also, (as it's inclusive of the visit). For Medicare and medicare like (MA/PMAPS), we append the modifier .25 to the office visit when we bill out the 90772. And if it's an injection only, like a B12 injection - we code out only the 90772 & J3420 - no office visit with it.
{that's my opinion on the posted matter}

 

[zaidaaquino]

CPT 90772 includes 99212. You can unbundle it by using modifier -25 on the E&M if in fact it is a significant, separately identifiable E&M serivce. (Are you also using a J-code?)

Zaida, CPC
Urology office

 

[BRETT]

Thank You!