Need a Modifier for 99497 when I have other services as well

tbaker808

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I can claim 99214:25 along with 99497 and get paid for both. But I sent a claim to WPS Medicare for a patient as follows
99214:25
99497 (Advanced Care Planning)
96372:59 (injection)
J3420 (B-12)
Medicare did not pay 99497, saying it was combined with the injection. So they paid the 99214, 96372, & J3420. When I called WPS, the rep said the 99497 needed a modifier in order to get paid. Modifier 59 does not work for the 99497; I tried that too. Do they want an XU modifier?
I've been accustomed, when I have multiple distinct services, to leave one procedure/service "un-modified" and then put the 59 on the next (less costly) procedure(s).
 

burkefam

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EM code

Try modifier 25 on 99497 since it in of itself is an EM code, and to distinguish it from the injection fee, you can use it. I have done two mod 25's on claims before...
 
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25 can be used twice, but make sure the documentation clearly supports each individual service.
 
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