Question: A payer denied our claim for an established patient office visit in addition to 96372. We appended modifier 25 and appealed but were denied again. What are we doing wrong?
Texas Subscriber
Answer: If you’re billing a payer that follows the Correct Coding Initiative (CCI), the edits bundle office visit codes 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient …) into therapeutic injection code 96372 (Therapeutic, prophylactic, or [...]
