• 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 the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Preventative Exam on Same day as E/M AND injection

Create Wiki
K

k.keller

New
Messages
3
Location
Bogart, GA
Best answers
0
We have several patients who have come in for their annual preventative exam. While here (as always) they are also seen for some other medical issue and are charged with a separately identifiable E/M code and a -25 modifier is added to this line item. The patient also receives a vaccination or injection by our nursing staff and the administration code 90401 or the injection code 96372 is also added. Because both the E/M code and the preventative medicine code are to be bundled into the vax injection or IM injection code, I've added a -59 modifier to this code. The carriers are all bundling the preventative exam in with the injection code. What am I missing? The injection code is in the column 1 for the NCCI edits, so perhaps a -59 modifier should go on the preventative exam code but this is not a procedure, which is what this modifier is for so I am just stuck!! I've contemplated adding a second -25 modifier to the preventative exam code but I've never seen this before - claim with (2) -25 modifiers? This started occurring with the 10/1/12 HCPCS update. Is anyone else experiencing this? How do I fix it?! Help!

Krystin Keller
 
I would add modifier 25 to the preventative code. I've seen this before and it looks odd, but it should compliantly get you paid.
 
maddismom said:
I would add modifier 25 to the preventative code. I've seen this before and it looks odd, but it should compliantly get you paid.
Click to expand...
Thank you!! I will try it all at this point but I want my appeal to be strong so I didn't want to just wing it! Thanks for letting me know that you have at least seen this before!
 
I also have added the 25 modifier to the preventative visit. It will pay. As long as you have documentation to support your visit charges there should be no worry. I would evalutate whether or not your separate E&M is truly justifiable.
 
You must log in or register to reply here.
Top