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Thread: Rac denial on 22525 cpt

  1. #1
    Join Date
    Apr 2007

    Unhappy Rac denial on 22525 cpt

    AAPC: Back to School
    my facility (hospital) just received several RAC denials for not adding a modifier to 22525.
    I know this is an add-on code and SHOULD not require a modifier.
    I'm wondering if there is anyone else out there that has had these denials for not adding a modifier.
    Every article I'm finding is stating not to add modifiers. I haven't been able to find anything
    "official" from CMS. Can anyone provide a link to CMS for this, if there is one?
    Thanks very much.

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    What were all the codes submitted?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    Coastal Coders


    We have been forced to add modifiers to add on codes. Specifically to 99292.
    When 99291 is submitted with a 25 we must put a 25 on the second level.
    So when you submit 22524 and it's modified (which wouldn't surprise me with the code set these days) then I would expect the add on is going to require it as well.
    They shouldn't however be asking for something other than what is on the parent code.
    There is so much overlap in these codes that I expect we will see a major overhaul in them soon.

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