E&M and cast applicaton

Kalispell, Montana
Best answers
WC is denying a NP visit where the doctor determined that patient had an avulsion fracture. We billed an E & M code 99203 with mod 25, application of cast 29075, supply code, and x-ray. We appealed it and the adjuster told them to pay it but they are still denying because it is a minor surgical procedure based on 2016 NCCI policy Manual. They say the E&M has to unrelated to the decision to perform the minor surgical procedure. If we had made a decision for surgery and billed a 57 they would have paid for it. Dr. made decision that fracture care not warranted, reviewed x-ray, ROS, exam, MDM, assessment & plan to treat with cast, scheduled patient back to follow up. Any feed back would be appreciated.