Wiki E/M denial

[Belarm3]

Good morning,
I am looking for some advice on the following scenario and would appreciate any help you could offer. I am receiving a denial on a patient that received a pic line insertion in the morning and was seen by a different provider later that day for an E/M. The E/M is being denied by the payer. Any thoughts on what the correct modifier should be on the E/M? Obviously, 24 wont work because the two visits were with different providers. Any suggestions?
Thank you.

 

[cgaston]

You should use a -25 modifier on the E&M when you have an E&M and line insertion on the same day.

 

[mitchellde]

If the providers are in the same specialty and same practice then the E&M should not be billed. A 25 will not work in this instance.

 

[cgaston]

If the patient is seen for something outside of the need for the PICC line the separate E&M can be billed with a -25.

The first thing that comes to mind is if the patient has a fracture with infection. The PICC line is indicated for the infection but if the MD treats the fracture (or anything else outside of the infection) during his encounter both would be separately billable.

 

[Belarm3]

Thank you all. I really appreciate the help.