tci E/M Coding Alert - 2022 Issue Q1

Reader Questions: Remember An Appeal is a Tool You May Sometimes Need to Use

Question: I have a maternal fetal medicine (MFM) doctor who does an inpatient evaluation and management (E/M) (99221-99223, 99231-99233 with 25 mod) along with a fetal non-stress test (NST) (59025-26). Medicaid of Alabama is denying the E/M and BC as bundled with the NST, even when the E/M has a 25 mod. Is this just a combination that cannot get paid? Alabama Subscriber Answer: First, check their policy manual for any specific rules, as these two services are not bundled, but it may be that this MD’s documentation does not support the E/M as being separate and significant...

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