RTabacco
Contributor
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?
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?