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Payment Problem


Best answers
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?


True Blue
Hibbing, Minnesota
Best answers
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.