UHC Billing Expert (IP EM 99221 - 99223 with Advance Care Planning 99497)

[Summer]

Seeking persons with UHC billing expertise please. Receiving denials.

Scenario: Inpatient EM billed with one of these CPT codes 99221-99223 with Advance Care Planning CPT 99497. NCCI guidelines say modifier can be used to override edit. IP CPT a column 1 and 99497 a column 2. Traditional Medicare Part B very clear on how to bill AWV with 99497. However, reading conflicting information for Inpatient EM with ACP. Some say use modifier -25 on ACP CPT 99497, some say to place modifier -25 on both codes and some say to bill IP EM with modifier -25 and ACP 99497 with modifier -25 and -33.

Currently group receiving UHC denials for being coded as 99223 and 99497 -25. Does anyone have any insights to UHC MA policy on these services being billed together?

Thank you in advance!

 

[nishaganesh]

Seeking persons with UHC billing expertise please. Receiving denials.

Scenario: Inpatient EM billed with one of these CPT codes 99221-99223 with Advance Care Planning CPT 99497. NCCI guidelines say modifier can be used to override edit. IP CPT a column 1 and 99497 a column 2. Traditional Medicare Part B very clear on how to bill AWV with 99497. However, reading conflicting information for Inpatient EM with ACP. Some say use modifier -25 on ACP CPT 99497, some say to place modifier -25 on both codes and some say to bill IP EM with modifier -25 and ACP 99497 with modifier -25 and -33.

Currently group receiving UHC denials for being coded as 99223 and 99497 -25. Does anyone have any insights to UHC MA policy on these services being billed together?

Thank you in advance!Hey did

Hey did you find out where the Modifier goes. Medicare Part B services for 99223 when billed with 99497, which services do we append the modifier

 

[Mpollok]

When billing ACP with an E/M visit both need the 25 modifier