Wiki Trouble seeing "significant and separately identifiable" RE MOUD services with 96372

RTabacco

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We perform MOUD services with a focus on PT with Medicaid. We are in Washington State.

I was questioned about how I do our billing.

PTs come in and their health and living situations are assessed. Medication management is done for medications the PT takes themselves. Basic E&M stuff. However, monthly we can provide injections of buprenorphine for the PT.

The E&M I bill is usually 99214.
For the injection I bill 96372.

We found that billing like this results in denials of 99214 and a payment on 96372. So, we added modifier 25 to 99214 and modifier 59 to 96372. With these modifiers in place both lines are paid. Using modifier 25 to say, another thing was done and modifier 59 to say this is the other thing.

In my understanding because the injection is not done every visit and it is not something the PT can take on their own at home (like other medications that are managed and prescribed for the PT to pick up and take at home) then the injection counts as significant and separately identifiable. So, my billing is accurate.

A coworker pulled into question ever using modifier 25. I am struggling to find supporting documentation for my line of thinking. So, I come to my AAPC community. Do you think I am correct in what I am doing?
 
We perform MOUD services with a focus on PT with Medicaid. We are in Washington State.

I was questioned about how I do our billing.

PTs come in and their health and living situations are assessed. Medication management is done for medications the PT takes themselves. Basic E&M stuff. However, monthly we can provide injections of buprenorphine for the PT.

The E&M I bill is usually 99214.
For the injection I bill 96372.

We found that billing like this results in denials of 99214 and a payment on 96372. So, we added modifier 25 to 99214 and modifier 59 to 96372. With these modifiers in place both lines are paid. Using modifier 25 to say, another thing was done and modifier 59 to say this is the other thing.

In my understanding because the injection is not done every visit and it is not something the PT can take on their own at home (like other medications that are managed and prescribed for the PT to pick up and take at home) then the injection counts as significant and separately identifiable. So, my billing is accurate.

A coworker pulled into question ever using modifier 25. I am struggling to find supporting documentation for my line of thinking. So, I come to my AAPC community. Do you think I am correct in what I am doing?


If you took a black sharpie and crossed out everything related to the injection, would the remaining note be enough to support an E/M charge, and what level E/M charge would that support? That's a good mental rule of thumb to use if you're ever questioning whether or not a modifier 25 might be appropriate. Not seeing the complete note, I can't say definitively.

I'm not sure why you're putting a Modifier 59 on the injection though. What else is being billed other than the E/M and the 96372?

96732 is the primary code in the NCCI edit pair with 99214. 96732 does not need a modifier.
 
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