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Billing Medicaid for 2 E/M Services

  1. #1
    Unhappy Billing Medicaid for 2 E/M Services
    Medical Coding Books
    We have several instances in our family practice where patients are scheduled for a preventative care visit and are seen for this, but in doing so all kinds of other medical conditions are adressed which would warrant an outpatient/office visit code as well. In the past, I've been able to modify the office visit code with a 25 in order to get payment from Utah State Medicaid on both codes. Now, I get denials back on the secondary code for "procedure combo not expected to be performed during same encounter". Does anyone have any suggestions as to how to get this legitimate coded combo paid? Thank you so much for your input!
    Last edited by WPFPBILLING; 05-10-2010 at 01:58 PM.

  2. #2
    Default preventive visits
    Is this Medicaid of Texas?

  3. #3
    Sorry... I did not specify... It's Utah State Medicaid... Original post has been fixed.

  4. Default
    For Missouri Medicaid, the 25 Modifier on the E&M works, but the preventative code needs to be billed first and the preventative dx (V20.2) must be the primary dx. If you are getting denials with the 25 modifier, I would suggest calling their provider customer service line and asking them why you are getting denials or if Utah Medicaid has their provider manuals online, try to look this up yourself. Was there a bulletin recently that stated that there would be changes when billing 2 E&Ms? In Missouri, we can subscribe to receive email updates anytime Medicaid makes any changes to their billing requirements. I would ask to see if this is available for future issues.

  5. #5
    Thank you for your input!

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