Mod -25

[karie]

I am coding a preventative maintanence chart. My E&M code is 99391. There are also 3 vaccines given. So I'm using 90465 and 90466x2 for the administration. My vaccination codes are: 90698, 90680, and 90744. Do I need a mod-25 on the E&M?

[bpct6501]

Karie, You shouldn't need a 25 modifier on the E/M. (You may find out that some payers require it, though.)

[snalley]

You do need a Modifier 25 on E/M code to let the Payer know that there is another code your billing.Modifier 25 should only be used on claims for E/M
services, and only when these services are provided on the same
day as another procedure. Thanks

[btadlock1]

I got a denial today for 99391, saying that it's incidental to 90465. I called to ask why, since the guidelines on those 2 codes are practically the only place in the book that 25 modifiers aren't mentioned, and the supervisor of the customer service department told me that since we did a face to face counseling with the pt for 90465, 99391 denied as incidental. I said that we had to perfom face to face counseling in order to bill a 90465, and not a 90471, and that it shouldn't matter either way, because the guidelines say that the are to be reported separately and they don't say a mod is needed. They told me that if I disagree, then I must appeal in writing. Needless to say, I've appealed in writing. If they're going to make up their own coding rules, the least they can do is post their policy and rationale somewhere that it can be easily referenced, like United Healthcare does. We shall see...