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Need help w/billing

  1. Question Need help w/billing
    Medical Coding Books
    When we have an office visit 99214 and used mod 25 and an inhalation treatment 94640 with 1 diagnosis only - is there a better modifier so the inhalation treatment will be paid

  2. Default
    To my knowledge you should report modifier -25 on the E/M but no modifier is reported with the neb treatment. If you administer more than 1 neb treatment you can append modifier -76 to the additional neb treatments. Also bill for your drugs if you can...

  3. #3
    Talking 99214 w/mod 25
    There is no better modifier. 25 is the correct modifier and insurance should pay both charges. :d

  4. Default
    That is correct, attach -25 mod to the 99214 and most insurances should reimburse both charges

  5. #5
    Default
    Yes modifier 25 is correct but from my expierence some insurance do not cover this because they say it is still considered experimental.
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  6. #6
    Default
    I also agree with Herbie I have heard than some are having trouble with certain payors for this code. The modifier should be -25, though, so you are correct.

  7. Default
    You dont need a modifier for just one treatment, but like someone answered earlier, if there is two txments use 76 modifier for BCBS especially. Most other insurance payers like 59 modifier, example Cigna and Aetna. But with BCBS, I know they only pay for a limited amount of 94640 treatments so check out the payer guidelines for this procedure if you are getting denials.

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