Scrawshaw
New
I code for a hospital. I do their OP and ER Visits.
the situation I am at in is my company I work for received a denial for needing a modifier 25 on EM.
I billed a ER visti(99283) under one provider and Xray's are done the same day so I billed x-rays under a radiologist.
They not only want me to place a 25 modifier on the EM code on this claim but start doing it to future claims I work on that have certain insurances...
Ex:
Sandy MD: 99283-(BcBS wants me to put a 25 mod)
joe (radiologist): 73030-26
I said to them No, you do not need a modifier 25 on the emergency department (ED) E/M visit if you are an ED provider billing for the E/M service and a radiologist from a different specialty is billing the interpretation.
Modifier 25 is used to indicate a significant, separately identifiable E/M service by the same physician on the same day as a procedure.
Now my problem is I found out all my other coworkers are billing with a 25 modifier when another provider bills a diagnosis test service like x-rays. my boss even sent an email stating to remember to do this... I am alone in this fight and because I can't find any info stating this is ok and when I ask my coworkers their explanation doesn't make sense to me... it like they are saying "We do it this way and it gets paid" or shows me old policies and they still don't state what they are doing is ok. I am telling them the denial is most likely an error on the insurance side and just needs and appeal but I don't think they are wanting to listen...... Am I missing info out there that is stating I need to put the 25 modifier on the EM visit for this kind of scenario of separate provider billing? or can you guy help me show proof that in this kind of scenario a 25 is not needed?
the situation I am at in is my company I work for received a denial for needing a modifier 25 on EM.
I billed a ER visti(99283) under one provider and Xray's are done the same day so I billed x-rays under a radiologist.
They not only want me to place a 25 modifier on the EM code on this claim but start doing it to future claims I work on that have certain insurances...
Ex:
Sandy MD: 99283-(BcBS wants me to put a 25 mod)
joe (radiologist): 73030-26
I said to them No, you do not need a modifier 25 on the emergency department (ED) E/M visit if you are an ED provider billing for the E/M service and a radiologist from a different specialty is billing the interpretation.
Modifier 25 is used to indicate a significant, separately identifiable E/M service by the same physician on the same day as a procedure.
Now my problem is I found out all my other coworkers are billing with a 25 modifier when another provider bills a diagnosis test service like x-rays. my boss even sent an email stating to remember to do this... I am alone in this fight and because I can't find any info stating this is ok and when I ask my coworkers their explanation doesn't make sense to me... it like they are saying "We do it this way and it gets paid" or shows me old policies and they still don't state what they are doing is ok. I am telling them the denial is most likely an error on the insurance side and just needs and appeal but I don't think they are wanting to listen...... Am I missing info out there that is stating I need to put the 25 modifier on the EM visit for this kind of scenario of separate provider billing? or can you guy help me show proof that in this kind of scenario a 25 is not needed?