Wiki Office Visit W/ In-Office Manipulation

[screed@urhcs.org]

I have a question.....Is anyone having problems getting claims paid when a physician charges for an office visit with a manipulation done in the office? We are having problems with Medicaid paying these claims. Everyone else will pay them with no problem. The physician does the manipulation in office to be more convenient for the patient. Medicaid keeps bundling the office visit to the procedure. We have tried using modifier 57. Does anyone have any ideas?

 

[ammontagano]

Our Medicaid in CT will not pay for a fx charge and an Office visit for an established patient. It is either one or the other. They will pay for a new patient and a fx charge at the same visit, but you have to make sure the documentation supports it. Also attached a modifier 25 to the office visit for the new patient

 

[mbort]

Our Medicaid will not pay for any E/M code with a procedure code regardless of the modifiers used.