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ov with modifier 25 and injection

  1. #11
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    Quote Originally Posted by Bonnie Owen View Post
    Denial from BC today. OV w/ mod 25, 96372, and J code. 96372 denied inclusive to OV. No other procedures this day, thus no need for mod 59.
    99211? That's the only OV that should have caused that denial. (NCCI edit)

    What did your claim look like - list all of the CPT's, units, and Dx codes...a few of us might be able to help you find what's triggering it.

  2. Default
    I will check and get back with you. Thanks. Waiting to see what Medicare did on a claim.

  3. #13
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    Quote Originally Posted by Bonnie Owen View Post
    I will check and get back with you. Thanks. Waiting to see what Medicare did on a claim.
    Please do! My background is in commercial follow-up/appeals, so I'd be glad to try to help you get it paid. Just let me know!

  4. Default Modifier 25 on E/M with 96372
    Quote Originally Posted by Bonnie Owen View Post
    I was told by a fellow co worker that Medicare allows an office visit with modifier 25 attached when billing an injection of a drug ( example Kenalog for allergies/rash) to get the adm fee 96372 paid. I disagree. I say content of service and modifier 25 should not be used. I know Medicare now covers adm fee on vaccines with OV w/ or w/o mod 25 for the adm fee, but I have never heard of adm fee getting billed and paid for by Medicare with OV with other injections , not vaccines. I am not talking about trigger points or injections into hips/ knees. Drugs like depo medrol, Kenalog, tordol that go into the IM.
    Sorry it took so long to get back with the example: 99202 mod 25 J1040 X 1 and 96372 dx: 477.9/478.19/786.2. Blue Cross/Blue Shield paid OV, paid J code and denied 96372 as CO97, inclusive to other service.

  5. #15
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    Quote Originally Posted by Bonnie Owen View Post
    Sorry it took so long to get back with the example: 99202 mod 25 J1040 X 1 and 96372 dx: 477.9/478.19/786.2. Blue Cross/Blue Shield paid OV, paid J code and denied 96372 as CO97, inclusive to other service.
    Interesting - what did they tell you when you called? When I ran those in their claim editor, it shows to allow all 3 - I attached a screen shot of it.
    Attached Images Attached Images

  6. Default E/M w 96372
    Quote Originally Posted by mitchellde View Post
    What was the dx, the visit level and the drug?
    99214 dx 250.00, 251.2 and 401.9. J3420- B-12 injection with dx 266.2 and 96372 same dx.

  7. #17
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    Quote Originally Posted by Bonnie Owen View Post
    99214 dx 250.00, 251.2 and 401.9. J3420- B-12 injection with dx 266.2 and 96372 same dx.
    Did the B-12 deny?

  8. Default e/m mod 25 w/ j code and 96372
    Quote Originally Posted by mitchellde View Post
    What was the dx, the visit level and the drug?
    I posted this yesterday but do not see the listing so I am reposting info. 99202 mod 25, dx 477.9, 478.19, 786.2 with J1040 and 96372 same dx. 96372 denied inclusive to E/M.

  9. #19
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    Quote Originally Posted by Bonnie Owen View Post
    I posted this yesterday but do not see the listing so I am reposting info. 99202 mod 25, dx 477.9, 478.19, 786.2 with J1040 and 96372 same dx. 96372 denied inclusive to E/M.
    You posted that one a few days ago - BCBS's claim editor shows that all three of those should pay - what did their CSR's tell you when you called? I think that denial is an error.

    The one you posted yesterday was for J3420 - did the B-12 deny? If so, the injection admin won't be covered either.

    I suggest calling BCBS and asking about these denials. They're not correct if the drug codes are paying.

  10. Default denial
    Quote Originally Posted by btadlock1 View Post
    Did the B-12 deny?
    B12 did not deny, it's 96372 denying cos. Where are you located?

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