Forwarding this answer from Dr. Whitten's office, our local CMD, regarding
their answer to a question I had on reduction of vascular study payment.
happened when the E&M code was sent in without the modifier 25 when the
was seen in office and had a vascular study the same day.
>From: "Linda Windley" <[log in to unmask]>
>To: <[log in to unmask]>, "Diane Seagroves" <[log in to unmask]>
>CC: "dick whitten" <[log in to unmask]>
>Date: Fri, 16 Feb 2001 13:50:35 -0800
>Sorry for the delay in this response, but I have been in training.
>You are correct, you will not need a modifier when billing an e/m and
>vascular study on the same day.
>The claims that were denied because of no modifier, you need to resubmit
>with the modifier.
>Claims where the e/m was paid and the vascular study was reduced, you need
>to ask for an appeal. You might try a telephone appeal first. You will need
>to tell the rep. that the vascular study was reduced by the allowable for
>the e/m. You want to add the 25 modifier to the e/m so they will need to
>adjust the vascular study also, and pay it at the full rate. I hope this
>makes sense to you.
>Remember the requirement for the modifier is a temporary suspension, HCFA
>may bring it back in the future.
--- Diane Seagroves RVT
Olympic Vascular Lab
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