ollielooya
True Blue
Colleagues,
This code has been discussed before as one that is not usually payable and bundled into an office visit. Ever so slowly we're seeing some of these pay. A major insurance company posted on one of their bulletins that they would recognize this code for payment beginning April 1 of last year. Up until this point they have made no payment, and today found out that the issue may be the need to add modifier 25. Patient presented to the office with no appointment for acute care, disrupting the normal office flow. Otherwise, they would have gone to the hospital. Doctor performed an E/M, then a procedure. We billed 99058 in addition. It was "bundled".
Does modifier 25 really need to be added to this adjunct code? Is this a case of "carrier" specific guidelines and our being compliant to their billing requirements?
---Suzanne E. Byrum CPC
This code has been discussed before as one that is not usually payable and bundled into an office visit. Ever so slowly we're seeing some of these pay. A major insurance company posted on one of their bulletins that they would recognize this code for payment beginning April 1 of last year. Up until this point they have made no payment, and today found out that the issue may be the need to add modifier 25. Patient presented to the office with no appointment for acute care, disrupting the normal office flow. Otherwise, they would have gone to the hospital. Doctor performed an E/M, then a procedure. We billed 99058 in addition. It was "bundled".
Does modifier 25 really need to be added to this adjunct code? Is this a case of "carrier" specific guidelines and our being compliant to their billing requirements?
---Suzanne E. Byrum CPC