Medical Billing Forum

Coding => Coding => : elle January 07, 2011, 05:47:53 PM

: Billing for a level 4 visit with a shot
: elle January 07, 2011, 05:47:53 PM
I submitted a claim to Health Partners for a level 4 visit.  I added a line of service for a B-12 shot.  They have denied the level 4 (131.00) office visit, and are only paying for the B-12 shot (43.00).  How can I bill for the office visit?  I called them and they told me that they can not help me.  We have seen this happen with Medicare too.  Any suggestions?  Would a modifier 25 work? 
: Re: Billing for a level 4 visit with a shot
: Michele January 07, 2011, 10:20:32 PM
The 25 modifier would probably work, but you can't just add it.  You need to check with the provider to make sure that it's appropriate for what was done. 

Michele
: Re: Billing for a level 4 visit with a shot
: oneround January 10, 2011, 02:40:42 PM
Modifier 25 indicates significant, separately identifiable e/m was provided. If this is the case you also have to bill the appropriate J code to identify what was given. I don't believe that the 90772 will be paid without identifying the drug. I would appeal  with medical records showing the documentation of the office visit to justify the charge for the e/m. If the Dr. didn't document an e/m and the patient was only seen for the purpose of giving the shot, the denial is appropriate.