Medical Billing Forum
Coding => Coding => : elle January 07, 2011, 05:47:53 PM
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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?
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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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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.