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Deborah Posted Tue 15th of July, 2014 14:39:32 PM

My doctor saw a patient in the office and 99214 was billed. He wanted spirometry, pre and post and diffusion capacity performed at the same time. I billed 99214 with a 25 modifier, as I have done for years. Now only the visit is being paid for and not the tests. Has something changed or this there another modifier that they want us to use now?

SuperCoder Answered Wed 16th of July, 2014 05:42:27 AM

Which CPT code you billed along with E/M?

Deborah Posted Wed 16th of July, 2014 12:08:30 PM

I billed 99214 modifier of 25 and 94060 and 94729 no modifiers

SuperCoder Answered Thu 17th of July, 2014 02:07:14 AM

There was nothing wrong in your coding. Who is your Insurance? And what denial reason did they give you?

Thanks !!

Deborah Posted Thu 17th of July, 2014 16:15:36 PM

Medicare was the insurance carrier: C0-16. Claim/service lacks information or has submission/billing error, which is needed for adjudication. I have checked and re-checked and can find nothing wrong with the claim. I do it the same way all the time.

SuperCoder Answered Fri 18th of July, 2014 03:44:38 AM

The CO16 denial code alerts you that there is information that is missing in order for Medicare to process the claim.

I find nothing wrong with the coding. You should call the Medicare and speak with a representative to get the information needed to resubmit the claim.

Thanks !!

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