modifier help

liloreo

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HELP! I have a doctor that bills for an office visit (99212) with 99401. To get them both paid, would I add a modifier to 99401?
 

Chelle-Lynn

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99212 and 99401 do not require a modifier per CCI guidelines. However, depending on the payer with our providers there are certain ones that will not pay both without the modifier 25 listed on 99212 or without medical records. It is unusual but we have seen it a few times. 99401 is already defined as a separate procedure from the E&M code so in most cases you should not have a problem.
 
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