Wiki Bill Modifier 59 with an E/M code

Hello, we are recently getting denial from varies insurance such as Humana denying 99213/99214 with modifier 25 when patient has had a phlebectomy done day(s) prior. For clarification, can you bill modifier 59 to an E/M code? What is the best way to approach this issue?

Hello, You stated the "procedure was done day(s) prior". Per CPT Manual, Appendix A, Modifier 25 is defined as a significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified health care professional on the same day of the procedure or other service. So, in this case, modifier 25 would not apply. You can refer to the following resource for guidance on application of modifier 25. https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00153948. You can also refer to the CPT Manual, Appendix A for application of modifier 59. Additional guidance on application of modifier 59 can be found via the following link: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144545. Hope this helps!