Em services denying with procedure

mcgraws

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Currently our hospital claims that include e&m service on the same say as a procedure are denying inclusive to the procedure even though the e&m has a modifier 25.

When we bill hospital services for our physicians we are billing just that, the physician portion. Our doctors as not employed by the hospital, they have privileges to see patients at particular facilities. Our claim is being treated like a facility claim where all is inclusive.

Can anyone give me any insite in this matter.

Thanks,

tonya
very frustrated!
 

Anna Weaver

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Do the procedures you are billing with have a 0, 10, or 90 day global? 25 modifier for 0 or 10 days, 57 modifier for 90 days. Also, your documentation should be separate and identifiable for an E/M when you have a scheduled procedure. Most procedures already have an E/M built in and shouldn't have an E/M billed separately. If you could give an example of the documentation for both the E/M and procedure, you might get more directed help.
 
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