Author Topic: Which modifier should I use?  (Read 989 times)

jcfenfen

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Which modifier should I use?
« on: April 13, 2011, 12:32:38 PM »
Hi,

I am billing for internal medicine doctor.  For a claim I billed CPT 99204, 90715 and 17110 on the same service date, and United only paid for 90715 and 17110 and stating that 99204 is included as part of the global service, and this charge is not eligible for separate reimbusement.  I called United Healthcare and they told me to bill with a code stating that 99204 is a separate service.  But what is that code or modifier?  Can anyone help? This is kind of urgent.  Thanks so much for any input

DMK

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Re: Which modifier should I use?
« Reply #1 on: April 13, 2011, 01:56:43 PM »
-25 means "Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service"

Since it was a new patient exam, there would be a history and review of systems before the doctor got to whatever procedure the patient needed.  The doctor's notes should support that.


DMK

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Re: Which modifier should I use?
« Reply #2 on: April 13, 2011, 01:57:36 PM »
And the -25 goes on the 99204 (E&M) not the procedure.