Wiki Neb Treatment with Office Visit - I am getting

[vhammons]

I am getting a denial on a 99214 with 94640 from Wellmark of Iowa. I did put a modifier 25 with it and still getting denied. Any suggestions?

Thank You

 

[mitchellde]

sometimes it is the dx code you used. what does the denial state what was the dx code.

 

[MarcusM]

http://www.aafp.org/fpm/2004/0600/p24.html
Office visit & nebulizer treatment
Q: What codes should I submit if, during a problem-oriented office visit, I decide the patient requires a nebulizer treatment and the nurse gives the patient instructions on using a nebulizer or metered dose inhaler at home?

A: You should submit the appropriate evaluation and management (E/M) office visit code, the code for the nebulizer treatment (94640, “Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device)”), the code for the nurse’s instructions (94664, “Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device”) and the correct J code for the supply of the nebulizer drug. You should also add modifier -25 to the E/M code to indicate that it was a significant, separately identifiable service from the other services described.

 

[erjones147]

I just got paid for the first time for a 99213-25, 94640 from Medicare, but I have also had 94640 denied by both Medicare and private payers. My guess for your situation is either they are denying d/t a "medical necessity" reason, or they are denying because they are claim the neb treatment is included in the office visit

What does your error code claim the reason is?
Also, have you EVER been paid for a 94640 from that payer?

 

[mitchellde]

if you use the unspecifed dx code they almost always deny for medical necessity.