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Facility charge for E&M and procedure

  1. #1
    Smile Facility charge for E&M and procedure
    Medical Coding Books
    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. Default
    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
    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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