An orthopedic provider saw a patient as a new patient and billed 99203 for a right thumb sprain and on the same day also treated a right little finger fracture with 26720. They billed a 24 modifier on the office visit to allow us to pay for the new patient visit. Our billing system doesn’t allow this and considers it to be unbundled. If they would have billed the new patient visit with the right little finger fracture diagnosis with modifier 57, then I would have no issue allowing both services, but modifier 24 on the same day as a major surgery isn’t working. Modifier 25 isn’t correct for them to use either since it’s a major procedure with 90 global period. Am I still correct denying the new patient office visit with modifier 24 with a completely different diagnosis?
26720-F9 with Right Little Finger FX diagnosis
99203-24 with Rt Thumb Sprain diagnosis
Both procedures were performed by same doctor, on the same day. We denied 99203 and the provider resubmitted the claim by adding modifier 59 to line 1. It still denies 999203 as being unbundled.
26720-F9 with Right Little Finger FX diagnosis
99203-24 with Rt Thumb Sprain diagnosis
Both procedures were performed by same doctor, on the same day. We denied 99203 and the provider resubmitted the claim by adding modifier 59 to line 1. It still denies 999203 as being unbundled.
