Wiki Modifier Help

[lminneti]

Hi All,

I have been getting denials with ov and injections on the same claim. Ins are saying that i need to have a mod on the ov because without the modifier 99213 is bundled 90471. So i'm looking at 99213-25 with 90471 and 90715 or 90686. Is this correct? Every time our clinic does an injection with the ov its coded with mod 25? Wouldnt this send a red flag from the ins as over use of the modifier?
Thanks

 

[meghanhannus]

Hi All,

I have been getting denials with ov and injections on the same claim. Ins are saying that i need to have a mod on the ov because without the modifier 99213 is bundled 90471. So i'm looking at 99213-25 with 90471 and 90715 or 90686. Is this correct? Every time our clinic does an injection with the ov its coded with mod 25? Wouldnt this send a red flag from the ins as over use of the modifier?
Thanks

Hello lminneti,

Modifer 25 is the correct to use as long as an e/m service is a significant, separately identifiable service by the provider or other qualified health care professional on the same day of the procedure or other service to indicate a significant, separately identifiable E/M service was provided, the claim may be paid. If the patient presented simply for a scheduled vaccination appointment than a separate e/m would not be a billable service. Yes, you are correct that billing every vaccine with an e/m with the modifier will send a red flag to the payor and could cause an audit on your claims.

Hope this helps further clarify~

M.Hannus, CPC, CPMA, CRC