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Railroad Medicare
I submitted an office visit and a surgery code on the same date of service. Why was the office visit denied?

Answer:
Modifiers may be required with some evaluation and management (E/M) services. In other cases, the E/M service may not be separately payable, such as certain visits performed on the day of a surgical procedure. Before submitting these services, ask yourself, 'Is this visit on the same day as I decided to perform the surgery? Is this the day before major surgery? Is this office visit a significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service?' If you answer yes to any of these, refer to the Modifier Lookup on Palmetto GBA’s website. CPT modifiers 24, 25 and 57 may be applicable. If an applicable service has been performed and the correct modifier is not on the E/M service, the E/M will be denied.

 

last updated on 10/13/2014
ver 1.0.51