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99354 Denying at Medicare

  1. #1
    Default 99354 Denying at Medicare
    Medical Coding Books
    Medicare is denying the use of 99214 & 99354 stating it is bundled. Since 99354 is an add on code we wouldn't put a modifier on it. Any suggestions?
    Thank you I appreciate any advice!

  2. #2
    Columbia, MO
    It could be your dx code is not supportive of that intensive of a service. I have never had a problem with Medicare paying for these, but you must remeber that this combination of level 4 plus prolonged time indicates an extremely intensive encounter. If you documentation supports this as well as time spent then appeal it, time spent must be for your scenario a minimum of 55 minutes spent face to face patient to physician.

    Debra A. Mitchell, MSPH, CPC-H

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