Forum - Questions & Answers

Jan 1st, 2014 - rthanks68

Billing Issues

I am new to billing. Have a situation and not sure how to bill it out.

Our office is a FNP-C and is the only provider in the officer. Actually her clinic. Have a PT that comes in for an office visit (99214) and then has IV Therapy after the visit with provider.

Have been billing 99214 w/ mod 25, 96365, 96366, 96372, J3420. The 96372 and J3420 is actually give to patient through the injection not the infusion. Molina is denying all my 96365 and 96366 procedures but pay the 99212 or 99214 with the modifier. If I leave modifier off they don't pay the 99212 or 99214 but pay the 96365 and 96366. They don't pay for injection or the medication.

Can someone please help me determine the right modifier or correct billing procedure

Jan 2nd, 2014 - agent00711   151 

re: Billing Issues

Can you advise the reason the carrier has given for the denial? Also, have you check their payment policies regarding the service? When checking the CCI edits, I show all codes should clear with mod -25 appended to the OV but again, you may need to check the carrier's payment policies.

Jan 2nd, 2014 - cmc2012 14 

re: Billing Issues

If you don't mind me asking... Which medication was infused? Did you bill the medication as well?



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