Routine physical with 94010. Help!

I am really having a problem with routine physical exams billed with spirometry. The insurance companies are bundling the exam with the 94010. I tried sending corrected claims with:

99395
94010-59 also using pointer to dx that necessitated the spirometry

My corrected claims are not paying, either. I'm having the most problems with UHC. I've check CCI edits and no modifiers are necessary. I went ahead and tried the 59 because it didn't pay without it. I have claims dating back to April 2011 that I'm still trying to get paid. Any insight at all would be most welcome.

Thank you

re: Routine physical with 94010. Help!

What diagnosis are you using for PFT.

re: Routine physical with 94010. Help!

V70.0

re: Routine physical with 94010. Help!

Could be they don't pay for screening.

re: Routine physical with 94010. Help!

But, they aren't denying the spirometry. They are paying for the spirometry and telling me to write off the physical.

re: Routine physical with 94010. Help!

You need to add modifier 25 to the well exam. Then, no modifier on the spiro.

re: Routine physical with 94010. Help!

I thought a '25' modifier could not ever be used on a physical. Only E&M. Modifier -25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.

I'm not at all trying to be argumentative. I'll try anything at this point. But, I'm pretty sure you can only use the '25' modifier with eval and mgmt. What are your thoughts on that?

re: Routine physical with 94010. Help!

preventive medicine services are E/M services.

But, I'm not sure you'll get the spirometry paid as a screening. What is the medical necessity?

re: Routine physical with 94010. Help!

OK. I guess I mean I've always been told you can use '25' with office visits, but not preventative. Is that accurate? The diagnosis codes varies. I have six or seven claims out there. They are all conditions that support 94010. COPD, shortness of breath, etc. The only time I have trouble is when billing for preventative. I don't have this problem with office visits. And I don't have any trouble getting ECG paid with preventative. Only spirometry. Should I try using the 25 on the exam?

re: Routine physical with 94010. Help!

No mod on the physical
E/M-25 dx copd,sob
94010 Copd,sob.

re: Routine physical with 94010. Help!

There is no medical reason to do a spirometry as part of a physical. If the patient has a complaint like short of breath, then use that diagnosis to link to the spirometry, and as bilings123 noted you could also bill a 99213-25 with that diagnosis.

Let me add that there also no medical reason to do an ECG with a physical for a patient with no symptoms and no other health conditions. Insurers are a little more liberal in letting that slip through but it is still a waste of all of our money.