OBGYN Modifier 25 Question

dsoule

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Can someone please help. Patient comes in with suspicion of being pregnant. OBGYN does the exam to determine pregnancy then does an ultrasound to determine viability. When billing if you don't use the 25 modifier on the e/m the ultrasound gets paid and the e/m gets denied as bundled. My contention is there is more taking place than the limited amount of e/m related to the ultrasound and thus both codes should be paid. Anyone have any ideas or places where I can find some documentation?

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Dee
 
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If the patients insurance is a MediCaid type policy the program will only pay for the ultrasound. For other insurances, a non pregnancy diagnosis is required to justify the visit portion, such a something pertaining to her menses. Appeal denial with medical records.
 
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