rejection code 97

how will i know if a patient has been to another doctor prior to seeing the primary doctor and if so is there a way to get this paid? Please help.

re: rejection code 97

What was billed out and what procedure did the patient have prior? Need more info.

re: rejection code 97

a regular office was billed 99214 along with 81002, 36415. I dont know what was filed prior to this from another physcian. Patient only comes every three months.

**the benefit for this patient is included i the payment /allowance for another service/procedure that has already been adjuicated

re: rejection code 97

Hello:

Did you append modifier -25 to your E/M? The below is per CPT® Assistant:

The -25 modifier was intended to be used with the highest level of E/M service in any category. At lower levels of E/M services, the services provided (ie, history, exam, medical decision making) will likely be classifiable to an existing E/M code.

CPT® codes 36415 (Routine venepuncture and 90700-90749 (immunization injections) are minor, frequently billed procedures. These services are commonly performed with E/M services. Is it necessary to use the -25 modifier when reporting these services with evaluation and management services?

Code 36415 is a starred procedure. As such, it is not necessary to use a -25 modifier, as the starred services is typically done with other services. However, as with the -25 modifier, the other service should be readily identifiable.