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CPT 99393 denied as inclusive with office visits.

Vijay Posted Fri 13th of April, 2012 13:12:04 PM

we have billed the cpt code 99213, 99214 & 99393 in a single claim together, cpt code 99393 denied as inclusive with other office visits. when checked in CCI edit, found we can bill the claim without modifier, but when asked insurance representative, they deny to send the claim back for review & say that the denial is correct.

Please suggest if we need to submit these claims with any modifier.

SuperCoder Answered Fri 13th of April, 2012 13:22:02 PM

You can only differentiate from a preventive to normal E/M visit by appending modifier -25 on the same DOS. If patient has come for preventative E/M services and doctor encountered any abnormality or any preexisting problem in the process of performing preventive services and if the abnormality is enough significant to require additional work, you could append modifier -25 to the office visit codes provided that you should link different dx to the office codes. There is no any alternate way.

Vijay Posted Fri 13th of April, 2012 14:04:04 PM

Thanks for your reply.

I have another issue with office visit, can we bill 2 office visit under one single claim. (i.e CPT 99214 and CPT 99213 without an modifier)

We are coming up with an denial if we bill 2 office visit, with same primary diagnosis and the secondary diagnosis is different...

Thanks & Regards,
Awashesh T
Wideangle Outsourcing

SuperCoder Answered Fri 13th of April, 2012 14:07:06 PM

No, you should only bill one office visit as per apppropriate level on same DOS. If it is in different session with different primary dx, then you can. Don't go higher level and try to bill appropriate level of E/M for safety and compliance issue if higher level is lacking something.

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