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UCR 151: FAQs with Dr. John Lin - Increasing 99214-25 denials, what can you do; TURBT and stent placement can this be unbundled?

 June 30, 2023 

Mark, Ray, and Scott welcome back John Lin to answer more questions that have come into the Thriving Urology Practice Facebook Group. 

  1. My billers are now getting a sh*t ton of denials of 99214 billed with modifier 25. Our documentation is correct. We have sent in OV notes and appealed and the insurance companies still deny. Most of the denials are coming from Anthem but some from Cigna.

    We are taking it to the next level of appeals and involving the "patient advocate" for the insurer, but I'm not sure what else to do.

    This is maddening and I'm sure they're just hoping we give up, but I KNOW (because of John C Lin) that they need to pay me for these appropriately coded E&Ms!!

    Anyone else seeing this? What else can be done?

  2. 52332
    52235 51
    It was denied for unbundling.

    NCCI Edits show that this can be billed with a modifier.

    My CPT shows that we can bill 52332 with another procedure with Modifier 51

    52332 was done due to tumors overlying area of left ureteral orifice.

    Has anyone else had trouble billing these two codes together.

    Payer: Centene Ambetter, a Marketplace plan that pays better than Medicare.

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Dr. Lin is the administrator of The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/ 


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