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Old 10-22-2009, 01:26 PM
Trendale Trendale is offline
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Default 94640 with office visit/ modifier 25?

I have recently had United HealthCare deny an office visit (99213) when it was billed with a breathing treatment (94640) stating the office visit was part of the breathing treatment service. Medicare and other insurances do not deny either when performed in the same day and no modifier is required. Are you aware of some new bundling audit coming around the corner on this? Is this something that needs to be sent for review to United?

My experience is Medicare would be the first to deny if something changed in the coding world and I think United is just creating another reason not to pay a claim.

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Old 10-22-2009, 01:44 PM
LLovett LLovett is offline
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I ran this thru my claim scrubber and for WPSMedicare it does not require a modifier. For commercial carriers it is requiring a 25 be put on the E/M code.

I ran a report to see if we are getting denials. We are billing with the modifier 25 to our commercial carriers and without it to medicare and medicaid. Everything is getting paid that way, no denials.

I checked for 2009 and 2008. We are in Michigan.

Laura, CPC, CEMC
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Old 10-22-2009, 03:08 PM
Lisa Bledsoe Lisa Bledsoe is offline
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UHC follows their own coding/modifier guidelines. Use modifier -25 on the E/M. We have also found that they want modifier -59 on all procedures whether there is a CCI edit or not. Goofy.
Lisa Bledsoe, CPC, CPMA
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