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Billing for a level 4 visit with a shot

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elle:
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:
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

oneround:
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.

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