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Sherry Posted Thu 07th of December, 2017 09:22:42 AM
Insurance company is denying our visit because the patient was seen in the office and our Colorectal surgeon ended up performing an Anoscopy without anesthesia during the office visit as well. We billed this is as 99214-25 and 46600; what kind of information can I supply the insurance company to explain why this is ok to bill? We want to appeal this, but other then explaining this is not inclusive, I want to be able to supply actual guidelines and reasoning's behind it so we can fight having to write this off? Any assistance on this would be truly helpful. Thank you!
SuperCoder Answered Fri 08th of December, 2017 05:37:38 AM

The office visit will be billable separately if there is sufficient documentation to support your claim. This means that the appropriate levels of history, examination and medical decision-making for the office visit that you are going to report must be documented in the patient’s medical record.

If the office visit was very limited in terms of the history, examination and medical decision-making, or if the payers policy indicates that an office visit and the anoscopy cannot be paid separately, then you should bill only for the procedure.

If there is enough documentation to bill the office visit separately, modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) should be attached to the code for the office visit.

 

http://www.aafp.org/fpm/2003/0200/p23.html

https://www.supercoder.com/coding-newsletters/my-family-practice-coding-alert/reader-question-identify-separate-em-from-46600-article

https://www.supercoder.com/coding-newsletters/my-gastroenterology-coding-alert/reader-question-anoscopy-during-office-visit-article

 

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