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81003 and E/M same day

  1. Default 81003 and E/M same day
    Medical Coding Books
    We are getting denials for the U/A done same day as a visit. They state either bundled, or included in payment of another service same day. These are private Ins. not MDCD or MDCR. Should we be using a 25 on the OV?

  2. #2
    We've never used a 25 when billing a lab with an E & M; what is the diagnosis that warrants the UA?

  3. #3
    we have a couple of ins company that we had to add 25 to E&M to get the ua paid

  4. Default
    a number of things, it is not done routinely on every patient

  5. Default
    So, adding a 25 to the E/M is okay to do to get the U/A and the E/M paid?

  6. #6
    Yes. Some insurances' guidelines require the use of modifier -25 on an E&M (especially for a level 4 and 5 E&M) in order to process urine charges.

    Zaida Aquino

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