psych visit/E/M visit

ktress

Contributor
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York, PA
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Hi, We have an issue where a patient came in for a 99211, then they had a Psych visit 90806, Insurance is telling us that it is bundled. These were performed by 2 seperate physcians in our practice. Should we append a modifier? Would a 59 help get this paid? :(
 

tfreeland

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If a physician saw the patient, a 99212 instead of 99211 would be appropriate if you have the documentation (which you usually do). We only use 99211 for a nurse visit. Use mod-25 on E/M code if you do an injection admin at the same visit.

Terri Freeland, CMM,CFPC
 
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4,466
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Milwaukee WI
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99211 CAN be used by physician

99211 can be coded (if appropriate to the documentation) for a physician visit.

F Tessa Bartels, CPC, CEMC
 

RNCPC0709

Networker
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High Point
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99211 is NOT just a "nursing" code and is appropriately billed for services rendered by a physician. Aside from that, you should append modifier 25 to the 99211. The payer's system is probably reading the TIN# for both services and denying as it thinks both were by the same provider.
 

mitchellde

True Blue
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Columbia, MO
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I f these are two separate physicians, in 2 different specialties then you should be using 2 separate 1500s and there is no need for a modifier. If both physicians are in the same specialty then you cannot bill both encounters on the same day. Can you give more of the scenario for analysis?
 
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