Forum - Questions & Answers

Oct 14th, 2015 - vijayaslaan1128

99211 & 85610 (qw)

Hi i have a Query,
we billed 99211 and 85610 (QW) to Medicare. Initially we received payment, but later it was recouped and we have got a denial stating -CO236 as procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative. Can i add 25 modifier for 99211 and refile the claim. Or any other options? Can anyone please assist me..

Oct 14th, 2015 - LBAROGIANIS 250 

re: 99211 & 85610 (QW)

It appears you can't bill both codes together. On the 2015 fee schedule CPT® 85610 is only good for $5.35. I guess you would need to see the patient for two different things. One PT monitoring and that diagnosis to go with CPT® 85610. Then there must be a significant other reason to bill CPT® 99211. Code 99211 describes a face-to-face encounter with a patient consisting of elements of both evaluation (requiring documentation of a clinically relevant and necessary exchange of information) and management (providing patient care that influences, for example, medical decision making or patient education). Documentation must be legible and include the identity and credentials of the servicing provider.
If you bill both and you have great documentation and they deny it, then appeal it.

P.S. there is a wealth of information on this site and google.. Just google.. no pun intended.

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