Wiki Horizon denials to E&M when billed with 94060

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Madadudu

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Has anyone been experiencing Horizon denials to E&M codes when billed with 94060. We do have modifier 25 on E&M and still 94060 is being denied for being mutually exclusive. All this started happening in August . All other carriers do pay. We appeal but denials are still being upheld. It is against Horizon policy as well. Getting in touch with Horizon rep is impossible. We feel like our hands are tied. Please let me know if anyone else has the same problem and how are you dealing with this. Any tips, clues greatly welcomed and appreciated.
 
My code editing tool states: Code 99214 (RVU: 3.85) is included in 94060 (RVU: 1.17). 99214 (RVU: 3.85) may be unbundled from 94060 (RVU: 1.17) if you can justify the use of an appropriate modifier. If you are unable to justify the use of a modifier, you may only bill 94060 (RVU: 1.17). If you bill both, 99214 (RVU: 3.85) should receive the modifier.

Your E/M would have to be totally unrelated to your procedure and well documented. You should be able to appeal if the E/M was unrelated.
 
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