I was told that the proper coding for the 81003 is a 25 modifier on the office visit and a qw on the 81003. However, when billing this with an office visit and another procedure (say an injection) the code is denied. We ran it through claim check with a 59 modifier and they have paid however, we were told using a 59 modifier to get paid on a UA is fraud. Can someone shed some light on this topic? Also, did the UA code go to Go432 for Medicare or was that just the 80101?

Kelly M