Forum - Questions & Answers

Dec 15th, 2016 - Webb0825

OV Billing w/CPT® 94200

Is there any way to a claim paid for both OV code (99214) w/a Spirometry (94200). Our billing dept billed 99214 -25 & 94200- 59 but the office visit is being denied as inclusive. Is there any way to bill these codes to show that they're both distinctly different?

Dec 16th, 2016 - lisakay1957 11 

re: OV Billing w/CPT® 94200

My first question is why there was modifier 59 added to the procedure 94200. Modifier 59 is only to be used to indicate that a procedure or service was distinct or independent from other NON-E/M SERVICES performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, etc. You can find this information at the back of the CPT® book in Appendix A. I would suggest that someone in your billing department read up on how modifiers are used. The modifier 25 on the E&M level already indicates that on the day a procedure or service identified by a CPT® code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service was performed. I would take the modifier 59 off and bill it with the modifier 25 on the office visit. Good luck though as with my experience insurance companies don't usually pay on 94200 either when billed with an office visit

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