Wiki PROFESSIONAL COMPONENT

MRod2023

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Hi all,

I am billing the professional component- One encounter 75574.26 was billed to Anthem Healthkeepers & another encounter for same DOS we billed 99284.25. The 99284.25 was paid but 75574.26 was not paid- according to Anthem procedure 75574 with modifier 26 is bundled to procedure code 99284 with modifier 25.

Can anyone advise- Did I bill these services with correct modifier? Thank you!
 
It looks like your modifiers are correct. If you feel that the work the provider performed for the 75574 should be considered separate from the 99284, then I would recommend appealing. But if the documentation does not support it being a separately identifiable service, then there are no grounds for an appeal. If you have further questions, please feel free to contact me at themoldovans2001@gmail.com. Thanks, Vanessa Moldovan
 
It looks like your modifiers are correct. If you feel that the work the provider performed for the 75574 should be considered separate from the 99284, then I would recommend appealing. But if the documentation does not support it being a separately identifiable service, then there are no grounds for an appeal. If you have further questions, please feel free to contact me at themoldovans2001@gmail.com. Thanks, Vanessa Moldovan
Thank you for answering my question & thank you for providing your email address.
 
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