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coding Injections, Admin. and office visits

  1. #1
    Unhappy coding Injections, Admin. and office visits
    Medical Coding Books
    Hey,
    Can anyone give me information on billing 99203-25, 96372 and J1885. I'm being told by the office that's biling it that 96372 is being denied. These are commercial carriers that are doing this. Is there somwhere that I can find the rules for this in writing?

  2. #2
    Default
    Someone should check with the insurance company on the reason behind the denial. The 25 modifier is on the E/M so it all should be paid but maybe there is another reason?
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    I am in agreement with Pam. This should not be denied.
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Location
    Columbia, MO
    Posts
    12,526
    Default
    It should not be denying I agree check with the carrier on this.. CMS had a transmittal on this I believe it was july of 06 it may have been 05, where they stated it was incorrect to bundle the injection admin with the office visit when a 25 was appended to the OV.

  5. #5
    Default
    Quote Originally Posted by robinkea View Post
    Hey,
    Can anyone give me information on billing 99203-25, 96372 and J1885. I'm being told by the office that's biling it that 96372 is being denied. These are commercial carriers that are doing this. Is there somwhere that I can find the rules for this in writing?
    I believe this is one of those things that falls under "carrier descretion" I would start making a list of these carriers who are denying and then making phone calls to your provider reps for these insurances just to get clarification.


    I have 2 insurances that I deal with on a regular basis who will not pay th e96372.

    Good luck~!
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  6. #6
    Location
    Charleston, South Carolina
    Posts
    641
    Cool
    I agree that the first thing you need to do is find out WHY it denied. It could be carrier discretion, or it could just be data entry or something on the part of the carrier.
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

  7. #7
    Default
    Definitely call them and make sure it's not a "glitch". Years ago I had that with one of my carriers, different codes though, and each time I called they had to override the system. I was told there was a glitch.

  8. #8
    Location
    Morristown
    Posts
    40
    Default
    Be prepared to send documentation to substantiate the use of modifier 25

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