Wiki denial ER claim billing an EM code and procedure code

[kmg745511]

I work for a billing co we are billing an EM code and procedure code. We are getting paid for the procedure code but getting denied for the EM code ex. 99291 with 25 modifier and 31500. We are also having issues with inpatient billing 33960 on one claim then billing 33961 on subsequent claims. I tried appealing the denial referencing the billing of initial service. Can anyone shed some light on these issues.

 

[Amy Pritchett]

I would love to help you , but I need to know a few facts:
1. What insurance company is denying the claim
2. How are you reporting the services on the CMS 1500 for payment?

If you can provide me with an ER report showing this example, I would be most glad to help you.

Thanks

 

[kmg745511]

The insurance co is geisinger health the billing is 99291with 25modifier and 31500. The second issue is with Coventry health now Aetna better health. We are billing 333960 on 12/11/2013 then 33961 on separte days 12/12/2013,12/13/2013 etc.