• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
  • Important Note: We will be performing a scheduled maintenance on 1st November 2020. The site will be offline from 7:30PM (MT) till midnight. We apologize for any inconvenience this may cause.

Payment Problem

willlen

Guest
Messages
3
Best answers
0
I am billing Medicare for Doctor of Osteopathy (DO) using 2 codes: E/M code99213 with modifier 25 and code 98926 - osteopathic manipulation. For many years we got payment for both codes. Suddenly, week ago I got payment only for code 98926 and zero for code 99213 wich was bundled with code 98926. What happened? And what I can do?
Thanks
 

dmaec

True Blue
Messages
1,133
Location
Hibbing, Minnesota
Best answers
0
well, perhaps they feel that your E/M level isn't a significant separately identifiable reason. It has to be "above" and "beyond" the usual preservice and postservice work associated with the procedure. Certainly, it can have the same dx but if there really isn't a significant separate reason for the E/M it shouldn't be charged.
How often does the patient have this done? Maybe it's been flagged and they feel an E/M shouldn't be billed out with it.
you can appeal it, if you have supporting documentation. You can bill both with the modifier on teh E/M -"if" it meets the requirements.
 
Top