I am asking for everyone's opinion since I am new to the coding world. We have been having problems with insurance companies paying both an office visit and a procedure (ex. 69210 or 31231). This happens most often on established visits, which is understandable. However, we have been using modifier 25 on the office visit in addition to the 69210 or 31231, etc. for all kinds of visits (new, established, consult). Is modifier 25 the correct modifier to be using or like a modifier 51 or 59 on the procedure 69210 or 31231.
The office is now just billing for the procedure when it comes to an established, but shouldn't the docs get something on a new or consult as far as the office visit and procedure?
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