Wiki in patient consult w/ hemodialysis

[lsamith]

i have a doctor that sometimes turns in charges for hosp consult and does hemodyalisis same day for diff dx for both. we are getting paid and denied when we bill out 99255 for problem dx and 90935 for ckd dx with a mod 59 on 90935. but now we are getting denials from medicare. they want us to bill out 99255 with a 25 mod. my question is do i drop the 59 mod on the hemo?

 

[jenn13088]

You only need the modifier 25 on the E/M code. Leave the 90935 alone. I work for a nephrology practice in Syracuse, NY and we only use 25. You should get paid without any problems.

Jennifer Sprague, CPC

 

[brozier]

Yes, drop the 59 modifier since you are not doing multiple procedures and add 25 modifier to the consult. I worked Nephrology for 4 years then worked private dialysis clinic for another 4 years (facility side). I now work for a large group of surgeons but I miss Nephrology.