Wiki Inpatient E&M with NST

[JenniferEdwards]

I have a MFM doc that does an Inpatient E&M (99221-99223, 99231-99233 with 25 mod) with a NST 59025-26. The E&M is being denied by Medicaid of AL and BC as bundled with the NST, even when the E&M has a 25 mod. Is this just a combination that cannot get paid?

 

[nielynco]

I have a MFM doc that does an Inpatient E&M (99221-99223, 99231-99233 with 25 mod) with a NST 59025-26. The E&M is being denied by Medicaid of AL and BC as bundled with the NST, even when the E&M has a 25 mod. Is this just a combination that cannot get paid?

First check their policy manual for any specific rules as these two are not bundled, but it may be that this MD's documentation does not support the E/M as being separate and significant or that the purpose of the visit was the interpretation of the NST only. Make sure those facts are secure then appeal the denial if the documentation supports both.

 

[JenniferEdwards]

Thank you @nielynco ! It appears to only be the initial day, 99221-99223, that is being denied. It is a "column 2" code against 59025, but I have used the 25 mod. I have searched the full Medicaid manual for 59025 to no avail. The NST was done as part of the initial hospital day care by the specialist.

 

[nielynco]

Then it should be appealed assuming the patient was not admitted for delivery by this provider. If she was admitted for the treatment or evaluation of complications during the pregnancy which did not lead to a delivery within that episode of care you should be able to get both paid, and a modifier -25 on the E/M would be correct along with the-26 on 59025. Just be sure the 59025 represents an actual NST, and not simply labor monitoring - big difference in the documentation.