So I guess I wasn't very clear in my original post....
It a patient comes in for a diabetes appointment and receives the flu shot we would bill like this:
250.00
V04.81
99213-25 250.00
90658 V04.81
90471 V04.81
Previously we were billing without the modifier 25, but then the carriers started denying saying mod 25 was required.
NOW we are billing with mod 25 as shown above, but Utah Medicaid, PCN, and Baby Your Baby are starting to deny even when it is attached. When I called Utah Medicaid they are saying they will only cover the E/M OR the 90471, but not both. And of course they are paying the 90471 because it is a lower billed amount and denying the office visit. The person I spoke with also said that it will deny this way if both E/M and 90471 are on the claim regardless if there is a mod 25 attached or not.
My question is....Is anyone else having this issue? Is there a different way to bill this to get reimbursed? I don't think its right to only get payment for EITHER the E/M or the 90471 when in some cases it's perfectly correct to bill both!
It a patient comes in for a diabetes appointment and receives the flu shot we would bill like this:
250.00
V04.81
99213-25 250.00
90658 V04.81
90471 V04.81
Previously we were billing without the modifier 25, but then the carriers started denying saying mod 25 was required.
NOW we are billing with mod 25 as shown above, but Utah Medicaid, PCN, and Baby Your Baby are starting to deny even when it is attached. When I called Utah Medicaid they are saying they will only cover the E/M OR the 90471, but not both. And of course they are paying the 90471 because it is a lower billed amount and denying the office visit. The person I spoke with also said that it will deny this way if both E/M and 90471 are on the claim regardless if there is a mod 25 attached or not.
My question is....Is anyone else having this issue? Is there a different way to bill this to get reimbursed? I don't think its right to only get payment for EITHER the E/M or the 90471 when in some cases it's perfectly correct to bill both!