Currently, Healthfirst NY is doing something stupid and denying all E&Ms billed with a minor procedure even THOUGH there’s a modifier 25 on the E&M. We use modifier 25 appropriately so its not as though we’re abusing it.

I tried talking to Healthfirst but it’s like talking to a wall when you’re trying to dispute the claim with them that the E&M shouldn’t be denied because of the modifier 25.

I suspect it’s a system error on their end because they use to deny a claim entirely if there’s any j codes billed on the claim like J3301. To avoid denials, I just bill the injection, 11900, on one claim and then make another claim for the J3301 and that prevented the claim from getting denied.

I did a test claim and billed 99203-25 on one claim and 11100 on another for the same date of service, in the end this creates two separate claim numbers but no longer getting global denials for the 99203-25.

My question is, is there any problems in doing this? Splitting the office visit on one claim with modifier 25 and billing the procedure on another claim, for the same service date of course.