I have a Physician who practices GYN; He will do the standard pap test, and if the results come back with ASCUS, LSIL, Dysplasia, he will perform a Colposcopy (CPT 57454). Once the patient bx comes back, if he needs to do further testing in the clinic, he will then go to a LEEP procedure (CPT 57522).
The most problems I have been having is with Molina Medicaid denying the E/M code with the modifier 25 on the 2nd visit, the LEEP; the GYN does spend time reviewing the results, what testing will be done, what the patient can expect, etc. I append modifier 58 to the CPT 57522 for staged or related procedure. However, the E/M code keeps getting denied because of the 25 modifier.
I cannot use 24 because it is not unrelated to the Colp 57454. This is considered a 30-60 day Global period by this insurance. Can anyone help so I can get the E/M paid by the insurance? The pregnancy test before invasive procedures and the LEEP is paid, but not my E/M.
Thank you!
The most problems I have been having is with Molina Medicaid denying the E/M code with the modifier 25 on the 2nd visit, the LEEP; the GYN does spend time reviewing the results, what testing will be done, what the patient can expect, etc. I append modifier 58 to the CPT 57522 for staged or related procedure. However, the E/M code keeps getting denied because of the 25 modifier.
I cannot use 24 because it is not unrelated to the Colp 57454. This is considered a 30-60 day Global period by this insurance. Can anyone help so I can get the E/M paid by the insurance? The pregnancy test before invasive procedures and the LEEP is paid, but not my E/M.
Thank you!