Wiki Office visit denial with injection

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Madcoder

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I have a couple claims that the office visits were denied when an injection was given on the same date of service. After a claim reconsideration (and repeat denial) the response was:

Service being billed is not supported by the diagnosis billed and is not considered seperate and distinct from other services billed on same date of service.

I know it has to do with the Mod 25, but that is the only way to code a injection with office consultation.

99213 (25)
96372
J1750

ICD: 280.1, 530.81, 530.85

Anyone see anything wrong with this? This is a medicare advantage plan. We submitt this all the time to Medicare and other insurance companies with no issues.
 
It does not need a 59 modifier, but I believe it may have to do with the designation of patient self administered drug. You might want to check and see. I know I have looked at some LCDs that do restrict this drug.
 
I've submitted an appeal to try to get some answers. What's even stranger is that we've billed for this about 8 different times with same codes. 50% were paid. Makes no sense. I'll update findings.
 
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