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psych visit/E/M visit

  1. #1
    Default psych visit/E/M visit
    Medical Coding Books
    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?
    Katie Mills, CPC
    Billing Leader
    Hanover Family Practice

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

  3. #3
    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

  4. #4
    Milwaukee WI
    Default 99211 CAN be used by physician
    99211 can be coded (if appropriate to the documentation) for a physician visit.

    F Tessa Bartels, CPC, CEMC

  5. #5
    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.

  6. #6
    Columbia, MO
    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?

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