Wiki Denial for OV on same date as an infusion

mmorneau

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I'm wondering if anyone else is having this issue-- We have an infusion suite in our office. Every other month the Dr sees the pt when they come in for their infusion. We have added a 25 modifier to the OV and billed the infusion. All insurances have paid until approx 6-7 months ago. Was mostly Aetna but in the last few months UHC and BC are doing the same thing. The insurances are now bundling the OV with the infusion administration. Our coding advisor suggested I send a copy of the CPT book saying that adding the modifier allows the administration to be billable and payable. I did that with multiple claims but they continue to say it's bundling and are not paying. Our Advisor also says that we are the only office of hers that is getting this denial. Why would we be the only office? We have called the Insurance companies and asked them to show us their policy or CMS guidelines showing where the administration is not payable but all they do is hang up on us. Are other offices seeing this happen? I can't believe we are the only practice. Thank you for your input. Marlene
 
Some of the insurance companies are doing this. I have had denials for an office visit with unplanned injections. They will pay the injection codes along with the HCPCS, but not the E&M no matter what I do.
 
I'd send a copy of the Office Visit note showing that it is distinct and separately identifiable from the infusion service.
 
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