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question from peds gi office

Terese Posted Wed 22nd of April, 2020 17:04:34 PM
How do you bill on same day of service for a follow up visit for constipation and a rectal biopsy to check for hirschsprungs disease? Currently using separate diagnosis codes and a 25 modifier on the visit code (and AG on the rectal biopsy code if a MCal pt). They try to deny the visit code even though separate issues. Is the only alternative to have them come in for two separate visits?
SuperCoder Answered Fri 24th of April, 2020 06:39:18 AM


Thanks for your question.

As per the above documenation, the patient came in for the followup visit for constipation and after that provider performs rectal biopsy. Therefore, followup EM code with modifier 25 and rectal biopsy CPT code should be billed.

Kindly check with the payer policy and also ask for the EOB report for the denial.

Please feel free to ask, if you have any questions.


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