Medicare says 20610 Component of 99214

I billed 99214 with a 25 modifier, 20610, and J1030. Medicare completely denied the 20610 and stated that it was included in the payment/allowance for another service/procedure that has already been adjudicated. I had this issue using the 25 and 59 modifiers and did some research and found where people were removing the 59 modifiers and only leaving the 25. I did this and still got a denial- WHAT NOW???

re: Medicare says 20610 Component of 99214

you donot need to use 59. You need to use direction modifier (LT or RT).

Thanks
Asif

re: Medicare says 20610 Component of 99214

So if I add the RT modifier since it was the right knee, do I leave the 25 on the 99214 for the visit? or leave the 25 and add the RT to the 20610? will this cause it to not be considered a component any longer?

re: Medicare says 20610 Component of 99214

yes 25 would be with 99214 and you will add RT with 20610. Your claim would be paid.

re: Medicare says 20610 Component of 99214

Appeal

re: Medicare says 20610 Component of 99214

Thanks! I will try the RT modifier and if that doesnt work I will try to appeal this. Its been a huge issue!

re: Medicare says 20610 Component of 99214

Could it be possible that this patient is within a global period? If so, and if you meet the requirements to append modifer -25 you would need to append modifers -24, & -25 to the E/M as well as -79 to the arthocentesis if they are indeed unrelated. Also, you can resolve these claims quickly by contacting telephone review if your contractor has such a department as Cahaba.

re: Medicare says 20610 Component of 99214

I am still getting denials on this. I have tried everything I know to try. Appeals...RT and LT modifiers, no modifiers, 25 and 59 modifiers, modifier 25 only on the OV. I even tried changing the diagnosis codes on the office visit since that was routine and putting the diagnosis codes that were related to the injection only on the injection codes only and that didnt work. We only do injections during an office visit if the Dr. feels it is beneficial at that time, otherwise we do them a different day for this very reason. Im at a loss. We cant just stop giving injection to patients!- also the denial does not state that its in the global period, it states that the service is included in the payment/allowance of another code already paid. In this last cse they paid the 20610, and not the 99214.

re: Medicare says 20610 Component of 99214

Double check the patients medical records sounds as if this patient may be in a global period if so, you will need to bill as 99214-24,-25, 20610-79 ONLY IF the inj and visit are UNRELATED to the global condition if one exists.

re: Medicare says 20610 Component of 99214

Can you explain this to me?
I get this denial on a lot of patients and cant seem to figure it out. IF we do injections on a patient the same day as a visit it is never a planned injection. The patient will come in for their routine visit to be seen evaluated and speak about medications and so forth, IF during the visit the Dr. discusses with the patient that he thinks injections would help regarding whatever they discussed in the room then he will do them. They dont come in for the injections, however it is usually related to the same pain areas (DX codes) they came in to the routine visit for. I am new at this and feel stuck on these where they deny...sometimes its the 20610 they deny as being included and then sometimes its the 99214. I just need some help with this one, nothing has worked so far.

re: Medicare says 20610 Component of 99214

Did you put modifier -25 on E/M code?

re: Medicare says 20610 Component of 99214

I initially tried modifier 25 on 99214 and 59 on 20610, that didnt work so i was told to remove the 59 and leave the 25 which i did and that didnt work, so i was then told to try RT or LT which i tried and that didnt work either.

re: Medicare says 20610 Component of 99214

Time to ask payer and appeal

re: Medicare says 20610 Component of 99214

59 definately not appropriate for the 992xx. 57 is not either as it has a global day of 000 not 090. I think there is an underlying issue here. Maybe try to appeal withthe dictation proving it was deemed appropraite to bill. Check patient procedure history to make sure it is not bundling with a previoud date of servce.

re: Medicare says 20610 Component of 99214

Yes i did.

re: Medicare says 20610 Component of 99214

Evaluate your Office visit and see if modifier 25 is appropraite, 992XX codes will bundle with procedure codes with a 000,010,090 global day fee.

re: Medicare says 20610 Component of 99214

You need to put 25 with 99214 when you are biling 20610 and modifier LR or RT should be used with 20610 to support the necesity of 25 you will have to bill different diagnosis code with visit code to show the reason of visit is unrelated to 20610. Hopefully it will work.

re: Medicare says 20610 Component of 99214

I dis agree, you do not need a different diagnosis code, read your CPT® book page 567, clearly states different DX are not necessary.

re: Medicare says 20610 Component of 99214

Hmm I see this. Thanks lyndaw for lending me some knowledge. I appriciate this.

re: Medicare says 20610 Component of 99214

Office Visit and Procedure on the Same Day
By Betsy Nicoletti, CPC


When should a clinician bill an Evaluation and Management (E/M) service and a procedure on the same day?

??When the documentation supports that a significant, separately identifiable E/M
service was provided on the day of the procedure

??When the E/M service is medically necessary to the patient

??When the E/M service is separately documented

??When the documentation meets the criteria (history, exam and medical
decision making) for the level of service billed

Use caution if the procedure is a repeat, planned procedure. Often, only the procedure should be billed on that date.

If the procedure is a minor procedure, with global days of 0 or 10, use modifier 25 on the E/M service. If the service is a major procedure, with a 90 day global period, use modifier 57 if the visit was the visit at which the decision to perform the surgery was made.

When not to bill an E/M service and a procedure on the same day:

??When the patient is in the office for a procedure, and you stop by to say, “Hi”

??When you do not document the E/M service

??When the documentation is brief, and does not meet the components required
for history, exam and medical decision making

??When the service is not medically necessary

??When the procedure is a repeat, scheduled procedure and no new history or
medical decision making is needed or performed


Modifier -25 tells the payer that the E/M service was a significant, separate service from the procedure and was over and above what is typical pre and post procedure work. A separate diagnosis is not required. Do not routinely bill an E/M service with the procedure--make sure that it meets the requirements.

re: Medicare says 20610 Component of 99214

Have you checked to see if the patient is within a global period?

re: Medicare says 20610 Component of 99214

Did you add a 25 modifier to 99214? If this was a Synvisc injection that is part of a series of joint injections, Medicare's magic can keep track of that too. If you add a 25 modifier already, and the note supports a separately identifiable E/M service, you may have to ask for a reconsideration with notes. If the joint injection was planned and that is all the patient came in for, then the E/M would be appropriate to bill and you would want to correct the claim removing the E/M from the claim.