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need help from the billing veterans/specialists

  1. #1
    Everett, WA
    Default need help from the billing veterans/specialists
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    New patient visit 99205 for Nevada Humana/Gold patient being seen by our specialist with dx. 346.11 and 728.85. Also EKG 93000 with dx 786.05. Billed out: 99205-25, 93000. Humana pd 93000 but denied the office visit stating HCPCS modifier is missing/invalid. Upon follow up was told MCR no longer allows the two to be billed with a modifier 25. Did (have) I missed something? I do remember reading back sometime ago a thread concerning whether or not this can be done with such a high level visit but this is the first time such a denial has impacted us. Enlightenment, advice and discussion welcomed, secondary to "administrative necessity (?) ---Suzanne

  2. Default
    we are in CA, no modifer rq for EKG along w/EM; however, 786.05 is not covered for
    EKG, 786.50 is covered. We have never bill w/786.05 for EKG

  3. #3
    Everett, WA
    Medical Billing
    Thank you for taking the time to reply to my question. It was helpful. ---Suzanne

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