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Cathy Posted Mon 08th of January, 2018 20:49:30 PM
We have been noticing that if a patient has anything else done on the same day as a yearly exam like ie: 99395 and another procedure like a injection or mirena removal the insurance company will pay for the cheapest procedure. I am putting a modifier 25 on the yearly. We started telling patients that when they have their yearly we cannot do any other procedure. If the correct of am I billing wrong? I did not have any problems till 2017. Thank you Cathy
SuperCoder Answered Tue 09th of January, 2018 05:51:43 AM

As per the presented documentation, having a separate note for the second service (procedure performed) can greatly decrease the likelihood of having it inappropriately bundled or denied. No one item of documentation can count toward both services.

For example: If the diagnosis for the yearly visit, and procedure(s) performed are same, there are chances, that it may be considered as a bundled service.

Kindly check with your payer for appropriate denial reason.

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