• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Modifier 25 and 57

Create Wiki Sort by votes
C

clbcarey@comcast.net

Networker
Messages
29
Location
Coal City, IL
Best answers
0
New patient 99205 and scope 31575, with a decision for surgery following day w/90 day global. I billed 99205 57,25 & 31575. 99205 was denied ICES (modifiers) The scope was pd. What is the correct way to bill this out?
Thank you
 
0
Clbcarey@comcast.net, you are saying that a 90 day global procedure was performed the day after the doctor performed the new patient visit and the scope. Some payers do not require a 25 modifier on new patient visit codes since there is no way that the minor procedure was pre scheduled and new patients all need to be worked up before a procedure is performed. So, if a 90 day global procedure was performed on the very next day, I would try sending in a corrected claim with 99205-57 and eliminate the 25. If the decision to perform the 90 day global procedure was made during the new patient visit, but the procedure was not performed the next day, ie, it is 2 days away, a week away, etc, that means the new patient visit is not in the global. Then try sending in a corrected claim with just 99205. If that does not pay, send in a corrected claim with 99205-25.
 
You must log in or register to reply here.
Top