tci E/M Coding Alert - 2013 Issue 9

Reader Question: Modifier 25 Is Your Nebulizer + E/M Answer

Question: I just received a denial after reporting 99213 with 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or ippb device). Should I bill the 99213 with a 25 modifier or should I bill 94664 with a 59 modifier? The diagnoses were 486 (Pneumonia organism, unspecified) and 786.07 (Wheezing). Georgia Subscriber Answer: No Correct Coding Initiative (CCI) edit exists that would preclude you from reporting 99213 with 94664. However, many insurers do require modifiers on these claims anyway. Most payers will report that they want you to append modifier 25 (Significant...

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