P9612 and office visits


Local Chapter Officer
Union Gap, WA
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Are any of you adding modifier 25 to your office visits and also charging the P9612 and getting reimbursed by Noridian. I reopened claim adding modifier 25 and they told me that was not a valid unbundling code w/P9612.

Provider relations told me we could only charge out the office visit or the P9612 but not both together. P9612 is only when we are collecting a specimen with no visit.

What have you heard of experienced?

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I'm have no specific answer for you, but there is a bundle between these two codes. If you read the HCPCS II book carefully, P9612 does read as if it's just the collection of the specimen only, aka nothing was actually done with it. This is probably the reason a 25 wouldn't do much; because they aren't considering P9612 a "procedure" necessarily.

Was the collection used to perform some sort of test that day at that same place of service? Was the office visit related primarily to whatever the reason for the collection was? Did you check the fee schedule and see what the reimbursement is for P9612... as in, is it really worth the time and effort to appeal it to the ends of the earth?:rolleyes: