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Thread: Facility charge for E&M and procedure

  1. #1

    Smile Facility charge for E&M and procedure

    AAPC: Back to School
    I have a WC insurance that is denying 99283 because it was billed with procedure code 12001 on facility billing and it was billed on a UB.
    I'm not that familiar with facility billing and was wondering if there is a good argument to get the insurance to pay the E&M level? I was this was a usual practice when a procedure was also done. Any advise would be greatly appreciated.
    Thanks in advance.

  2. #2


    It appears that maybe you should review the place of service code and make sure the claim was submitted as outpatient and not UB.

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    facility outpatient claims are billed on a UB-04 but you still need the 25 modifier on the ER E&M with a procedure or they will not pay for both, be sure the rev code is 450 for both. Assuming this is a facility claim you are talking about.

    Debra A. Mitchell, MSPH, CPC-H

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