Forum - Questions & Answers

Sep 29th, 2021 - DDoug

Geico Denying Modifier 59 & 25. Why?

The entirety of our claims have been returned by Geico with the remarks of improper billing. We feel our documentation has delineated a different region from the spinal manipulation region. Geico has paid modifier -59 & -25 before without any issue. Currently, AllState and Progressive are paying the exact same codes w/ similar documentation, diagnosis, and SOAP notes. Further, Geico has also paid the same codes within the past few years. We do not see how else this could possibly be coded. Any suggestions as to why the denial? Geico has not provided an explanation.Second, does a -59 have to accompany a chiropractic manipulative therapy and the manual therapy technique and neuromuscular re-education? Just trying to get a clarification as to why they're denying after covering it in the past. Thanks

Oct 12th, 2021 - ChrisW   256  1 

re: Geico Denying Modifier 59 & 25. Why?

Sometimes it is just a matter of updating policies, just because claims are getting paid is not necessarily an indication they should be paid. I would suggest getting a copy of their policy.
We also offer a 2022 ChiroCode Desk Book and this is what it states on page 172, "Billing a 97140-59 Manual Therapy with a 98942 or a 98941. The likelihood of performing 97140 in a separate and distinct region other than the 3-4 or 5 areas adjusted is rather low. Remember that there must be a diagnosis for every area you treat. Some payers have begun to require documentation upon submission of this code, even with the modifier."Used with E/M
25- Significant Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service.
Not used with E/M
Modifier 59 is used to identify procedures/services, other than E/M services.

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