We are receiving denials for our E/M services that are being billed with testing received that same day (i.e. 92134, 92083). The denial rationale from Humana: According to our policy, which is based on the National Correct Coding Initiative Policy Manual, when an Evaluation and Management (E/M) service is reported on the same day as a global XXX procedure code, the E/M service is payable only if it is a significant and separately identifiable service. To be separately reportable, the physician must perform a significant and separately identifiable E/M service on the same day of service. The definition of “global” here just means that the service is billed for the global service, as opposed to being billed for just a component of the service (i.e technical component or professional component).
The global service is correct as our providers own all the equipment. We frequently perform testing on patients who are here for exams and have never appended modifier 25 to E/M services and don't feel that this is correct. Medicare and all other payers reimburse these claims. Any help or references to send to Humana would be greatly appreciated!
The global service is correct as our providers own all the equipment. We frequently perform testing on patients who are here for exams and have never appended modifier 25 to E/M services and don't feel that this is correct. Medicare and all other payers reimburse these claims. Any help or references to send to Humana would be greatly appreciated!