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ACP and E/M billed on same day

Erika Posted Wed 18th of January, 2017 16:08:22 PM
I am having trouble getting both 99214 and 99497 paid when done on same day. Which modifier do I append in order for carrier to acknowledge that the 99497 is not an "incident to" billing and should be paid separately? I have been advised to use modifier 25 on 99214 and/ or modifier 33 on 99497 code but modifier 33 indicates AWV which this is not. Should I put 25 modifier on both?
SuperCoder Answered Thu 19th of January, 2017 02:55:16 AM

When an ACP service occurs during another visit such as E/M, then cost sharing (copay/deductible) applies as for other physicians’ services.

ACP code may be billed on the same day as E/M code, provided that the time counted to bill the ACP code is only counted for the ACP service, and not also used to meet time-based criteria for the E/M code.

As you correctly said that modifier 33 indicates AWV, you may append modifier 25, however please ensure the documentation clearly supports each individual service and that the time elements are documented separately from the E/M service performed on the same day. Also, please check the payer peference in this case too. Hope this helps. Thank you.


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