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I had a patient(a claims representative for BCBSNC)call regarding their claim. They(BCBSNC) denied the 95851 because it wasn't done as a separate procedure from the office visit. The patient was told we just need to add a modifier. What modifier can I add? It wasn't done as a separate visit. I would think any modifier would still be denied since it wasn't done at a separate time. Anyone have suggestions?
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Hi Guest!
Great question. Based on what you described below.... "denied the 95851 because it wasn't done as a separate procedure from the office visit" - this leads me to believe the insurer may be looking for the modifier:
-25 - significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service
Hope this helps. Let me know if you have any further questions!
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Rank: Guest
Joined: 9/8/2012(UTC)
Posts: 1,851
Was thanked: 16 time(s) in 15 post(s)
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Rank: Guest
Joined: 9/8/2012(UTC)
Posts: 1,851
Was thanked: 16 time(s) in 15 post(s)
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