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99232 denied

  1. Default 99232 denied
    Exam Training Packages
    99232 - denied
    92980 - paid
    99291 - paid

    These services were performed on the same date of service. One MD performed 99232 & 92980, and the other performed 99291. Can anyone explain why 99232 is being denied?

  2. #2
    Kansas City, MO
    The E&M is bundled into the procedure. Have you ever accessed the NCCI edits? If not I would highly suggest you become familiar with them as it seems that many of your denials are due to bundling issues.

    As with most bundled procedures if the E&M was significant and separately identifiable from the procedure being performed you may add modifier -25 to the E&M visit.

    There are many coders that will tell you if the decision to perform the procedure was made at this visit you may append the -25 modifier, but per our Medicare carrier this is incorrect. You have to prove the visit was in fact significant and separate from the procedure.
    Olivia Price, CPC, CCC
    Physician Coder Supervisor
    The University of Kansas Health System

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