What kind of modifier do I need?

[jcfenfen]

Hi,

   I submitted a claim, but Anthem to pay for the office visit, the reason is that it's on the same day as the doctor does the procedure, I called Anthem and they told me I need a modifier to be able to get paid, can someone tell me which modifier do I need?  Thank you so much for any advice.

[jaxter]

Modifier may be refer to a third party like insurance company who will bear the whole cost, and you need to refer to your consultant and rest proceedings will be done by them, else doctor may be concern to the mode you pay, either the bank or the someone related to the doctor's staff.

[biller88]

Hello, if your still looking for an answer, I have no idea what the post above me is saying but I think you need a modifier 25, meaning, the procedure was a seperate identifiable procedure and you can attach that to your e/m code.

[Steve Verno]

It would help to know what codes you're talking about and the main reason(s) for the visit.

[mdearfield]

Yeah i agree with Steve! You can't always place a 25 modifier on a E/M along with procedure code just to get payment.  You need to look at the main reason for the visit and determine if the procedure was not in anyway involved in the E/M visit.  Good luck! 

[Steve Verno]

To add, lets say the patient came in for the procedure.  That doesnt mean you can bill an E/M and use modifier 25.