Wiki psych visit/E/M visit

[ktress]

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?

 

[neha.bhatnagar]

Did you used a 25 modifier with 99211? If not resubmit with 25 modifier.

 

[tfreeland]

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

 

[FTessaBartels]

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]

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]

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?