Modifier 25?

A physician in our office saw a patient in the ICU and billed 99291 (ICU Daily Visit) and 99292 (Additional 30 min). The doctor was called back later that day to perform a TEE on that same patient. The doctor billed for the ICU visit and for a 93312 w/TC and 26 Modifiers (TEE performance and reading). However, the insurance company denied payment for the TEE because they said that it was incidental to the icu visit + 30 that was billed and paid. Should we have used modifier 25?

re: Modifier 25?

When the service is performed in a hospital-inpatient/outpatient setting, the technical component is a Part A service, and not billable to Part B. Should not bill with "TC" modifier. The physician service should be billed with a “26” Modifier (professional component). Different time of day, use modifier -59.

re: Modifier 25?

Yes because the same procedure was done the same physician the same day even though it was additional 30 min it was part of the critical care,evaluation and management so the modifier 25 CPT® code 99292. Because the insurance company had already billed. He charged twice. Now he could have charged two procedures if it was done at the same time.