Wiki OV with a procedure

[karriedemas@yahoo.com]

Please help - I'm billing an office visit with a 25 modifier and the procedure and I'm starting to get denials from Medicare - we have always billed this way and now we are getting denied for this. Examples: Office visit with a Yag Cap or Office visit and Trichiasis Epilation. Should I be putting a 59 modifier on the procedure along with the 25 modifier on the office visit?

 

[Lynda Wetter]

I'm no familiar with the codes you are trying to put togrether but you should not put a 25 & 59 on the same ov.
If the pt was having this procedure planned then there should be no OV billed. (unless addressed other problems) It does look like if the codes you are billing are in the 678XX series then they have a global day attached to the procedure.
You would put a 59 if they made the decision for surgery that day.

 

[karriedemas@yahoo.com]

Yes, I should have clarified which proc codes I used

OV: 92014,25
Proc: 66821, LT ( I was wondering if I put a 59 on the procedure)

OV: 92014,25
Proc: 67820, E4

Denial states: This service requires that a qualifing service be received and covered.

Procedures are getting paid, not the office visit

 

[jmcpolin]

66821 has a 90 day global so if the decision was made at the time of the visit you would need to code
92014-57
66821

92014-25
97540 E4

Again only if the decision was made to do these procedures at the time of the visit.

 

[pantaz]

Your probably seeing the results of the new CCI edits that started 7/1/13 that severly affected optho. Office visits and ophthalmoscopies are being bundled to Laser and injections. Modifier 59 on procedures and 25 on office visit could break those edits, but from what we have been seeing from professinal entities, that practice is not recommened. They recommend holding the claims that until CMS offers more guidence.