I can't seem to get the E/M correct for this date of service and it keeps coming back denied denied denied. Here's what was done prior to this visit: Can anyone help with this?
01/30/2012 45380 (biopsy due to bleeding and mass of the anus)
02/06/2012 99212 (declare as neoplasm of rectum)
02/13/2012 45172 (cut out the mass)
02/17/2012 45317-78 (goes back for sigmoidoscopy as they cant get the bleeding to stop)
The patient came in to the ER on 02/17/12 at 1:00 A.M.- my physician goes in to do the consult and 'plans to admit and observe her' from the ER. At 6:00 A.M. that morning, he does a 'SOAP' progress note and sees she is still bleeding a lot so they take her back to the OR. I thought I needed to bill an ER visit initially with the AI modifier and 58- but then I went with the observation code- UHC is saying that anything else done that day- other than the sigmoidoscopy isn't billable. Is this right and if not, what code am I suppose to be billing for?
01/30/2012 45380 (biopsy due to bleeding and mass of the anus)
02/06/2012 99212 (declare as neoplasm of rectum)
02/13/2012 45172 (cut out the mass)
02/17/2012 45317-78 (goes back for sigmoidoscopy as they cant get the bleeding to stop)
The patient came in to the ER on 02/17/12 at 1:00 A.M.- my physician goes in to do the consult and 'plans to admit and observe her' from the ER. At 6:00 A.M. that morning, he does a 'SOAP' progress note and sees she is still bleeding a lot so they take her back to the OR. I thought I needed to bill an ER visit initially with the AI modifier and 58- but then I went with the observation code- UHC is saying that anything else done that day- other than the sigmoidoscopy isn't billable. Is this right and if not, what code am I suppose to be billing for?