Medical Billing Forum

Payments => Insurance Payments => Topic started by: rozannar on March 11, 2013, 01:02:21 PM

Title: Can we bill 99213 and 93015 together?
Post by: rozannar on March 11, 2013, 01:02:21 PM
Molina is denying for global bundling when we bill the above to codes together? Not sure if it is a common denial for any claims to Molina, or only for this claim? I do not see we per formed a surgery recently for this to be denied for global bundling. According to the billing S/W the billing is correct. They are simply asking to appeal. Any other related issues faced? Any advises please?
Title: Re: Can we bill 99213 and 93015 together?
Post by: PMRNC on March 11, 2013, 01:44:56 PM
Assuming this is peds/family?

You might have to use Modifier 25 with the 99213.  Check providers documentation JUST to be safe as they are cracking down on the misuse of modifier 25. IT must only be used to designate " a Significant, Separately Identifiable E/M service by the Same Physician on the Same Day of the Procedure or other Service."  Make SURE it's documented as such ..remember, if it wasn't documented, it wasn't done.

Title: Re: Can we bill 99213 and 93015 together?
Post by: Billergirlnyc on March 11, 2013, 10:10:57 PM
This issue sounds like the mod 25, like Linda stated, but 93015 (global code) is a stress test code and the E/M would need mod 25 otherwise the carrier will only pay for the stress test or in some cases deny outright and make your resub a corrected claim w/o the E/M. The E/M needs to be ABOVE and or unrelated to the stress test, if it's not then you wouldn't bill it at all. Like Linda stated the documentation must support the E/M w/mod 25. Like if the patient was scheduled for the stress test and the doc did an E/M only to confirm current conditions then that's not a mod 25 because it's not a sig/separately E/M service and you wouldn't bill the E/M. Now if he did the stress test and learned the patient had an onset of something new and different than the current condition, well you get it. It's not that the E/M service can't be done, it just needs to be exactly what Linda pointed-out, which your CPT book will back-up and the documentation will back-up.

But if you're saying the insurance denied the entire claim, then you might want to be sure there aren't any limits w/Molina on the patient's policy. Otherwise this claim should be paid w/the correct modifier to the E/M service.