Billing > Billing

well visit e/m with sick visit e/m plus mod 25

(1/1)

dmaney:
Any advice on billing the following scenarios:
A patient comes in for a well visit and also a sore knee (stated as the reason for visit).  We are getting reimbursed for the well but not the e/m involved in the knee (just an example).  We've been using well e/m plus a sick e/m plus the modifier 25.  No reimbursement for sick e/m.

A patient comes in for a well visit (as stated as the reason for the visit).  During the exam, a suspicious lump is found (now we have a sick visit, right?) Again, we've been using a well e/m plus a sick e/m with modifier 25.  No reimbursement for sick e/m.

Would using modifier 33 for preventative (well) help us to get reimbursed for dr's extra exam and medical decision making?

Michele:
I don't believe the 33 modifier is going to help.  Without knowing the reason that the e&m wasn't paid it is hard to say.  Have you tried calling the insurance carrier to see why the sick portion was not allowed?  It sounds as if it was coded correctly.

dmaney:
Have you been getting paid for sick visits in these circumstances?

Anyone else having this problem?  Or just us?

Will ask person in charge if she has called...

Michele:
If you bill for a well visit, and an E&M with a medical dx using the 25 modifier, they are usually both allowed.  Occasionally there is a plan that does not allow for both a well visit & E&M for sick visit at same time. 

deedee:
it depends on the insurance carrier because as far as I know not all of them allow it. I would check with the insurance carrier.

Navigation

[0] Message Index