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What Is Wrong?

  1. #11
    Medical Coding Books

    To add to what "priceor" stated....

    (-59) can also be used on "Medicine" codes....surprisingly enough....I learned that not too long ago while doing some audits. Prior to this, I, too, was under the impression that (-59) was only for "procedures".
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  2. Default Billing Coordinator
    We came upon this problem and it was quite frustrating for us. We discovered that some payors make quite a distinction on the way they pay for "physical medicine" codes and the contract for Medical Doctors may be different then for Doctors of Osteopathy. We finally came with an alternative code that seemed to be exempt for all the road blocks and that code is 97140. I would still make use of the modifier "25" if is in addition to another e&m visit if unrelated.

  3. #13
    Green Bay, WI
    Quote Originally Posted by willlen View Post
    I am billing Medicare for Doctor of Osteopathy (DO) using 2 codes: E/M code99213 with modifier 25 and code 98926 - osteopathic manipulation. For many years we got payment for both codes. Suddenly, week ago I got payment only for code 98926 and zero for code 99213 wich was bundled with code 98926. What happened? And what can I do?

    Both codes are billable together (providing that documentation supports them). Did you use the correct somatic dysfunction diagnosis for the OMT.
    I code for multiple DO's and they normally have a separate diagnosis for the office visit and the somatic dysfuntion (based on location) for the OMT.

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