Author Topic: Billing for a level 4 visit with a shot  (Read 1196 times)

elle

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Billing for a level 4 visit with a shot
« on: January 07, 2011, 02:47:53 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? 

Michele

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Re: Billing for a level 4 visit with a shot
« Reply #1 on: January 07, 2011, 07:20:32 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
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oneround

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Re: Billing for a level 4 visit with a shot
« Reply #2 on: January 10, 2011, 11:40:42 AM »
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.
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare