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Wiki M'care and M'caid

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hland

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Macon, Ga
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I have two questions:

We had a pt in the hospital and she has Medicare and Ga Medicaid, she had a I/D done on a abd abscess and we continued to see her 3 more days with her other isses. M'care and M'caid said they will not pay unless we have a modifier on the bills and modifier 25 won't work. Does anyone know what modifier you would use?

Also we had a pt come into the office that has M'care and M'caid and had a EKG done and they won't pay for that either. We had a 25 on there but they don't like it.

If someone knows something it would really be a big help.

Thank you
Hope
 
If you are trying to bill E/M visits during the post op period that would be your problem. Follow up for a certain amount of time is usually included in the payment for any surgical procedures. -25 would not be applicable.
 
If the other issues were not related to the I&D then you would use modifier 24 (unrelated E/M service by the same physician during the postoperative period). If they are related to the I&D they are not billable.

Not sure what modifer they are looking for with the ECG, there are no NCCI edits for E/M with ECG.
 
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