We recieve payment for the OV (In case of Established pts )Visit with -25 modifier the level of Visit should be more than 99211 .ie 99212 - 99215. I hope it applies similar to the New pts too .. Certain cases the Cerumen impaction would be only reason for the encounter ,then it is not appropriate to bill both the removal of cerumen and OV code .
In case of Established pts :
Most of the Family care Physician provides , just an B12 injection or any vaccination and they bill for both the Visit and admin . Medicare denies the same and pays only for the Admin code . Usually the admin code is inclusive in 99211 .
It is the Coders responsibility to make aware of the Physician office to ensure that , they are aware of this rule .
As said by others it is appropriate to use -25 to OV when the level of visit is more than the first level , if there is distingiushable service rendered by the provider and the reason of the visit should be clearly understood and there is correct E/M level is choosen .Dont link the primary dx as same for both the OV and the other service rendered , this may also provoke necessity for denial .
Note : refer the clinical Example section in Appendix C in CPT book for the CPT codes .
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