Francisco Posted Tue 16th of June, 2015 12:19:21 PM
A VNG test is done in office by our audiologist. (92540,92543,2547,92557,92567) I charged for the office visit also (99213) with a 25 modifier. During examination, the patient was found to have sensorineural hearing loss also. The dx used were (389.10, 386.11). Insurance is denying payment for the 99213.25. I thought if there were additional diagnosis, they should pay for the office visit. Can you please clarify for me? Thanks.
SuperCoder Answered Wed 17th of June, 2015 00:31:58 AM
If sensorineural hearing loss was diagnosed during the evaluation, then the insurance company should pay for it. If the intent at the start was only about doing VNG testing and during the evaluation new problem was detected, then E&M code should be supported. E&M service will be considered a separate identifiable service. Kindly get in touch with the insurance company and discuss about the same and refile the claim or else you can also file an appeal.