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#1
02-24-2012, 08:47 AM
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Modifier -25 for Radiology
Can you please let me know if your practice adds a -25 in the physician office/clinic setting when an xray is done in the office. As a remote/traveling coder all of the clinics I've coded for have not applied a -25; but now I'm coding in a hospital with managers that are well informed, and they state that office setting is different from outpatient. I know that in out patient if the procedure has an X or A status indicator it's not necessary, and the codes are usually appended if they do a procedure with an S or T status indicater. Can you please include a source? I read the CMS info that included a -25 with radiology, but it also included another procedure. Wouldn't the work done by the physician be picked up with the -26? Please help me; I really like to stay updated on the most ucurrent info. Does adding the -25 increase the revenue? Wouldn't that create a red flag, if they do xrays all the time?
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#2
03-01-2012, 11:54 AM
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I worked for big medical group and it actually all depended on the insurances. Normally you wouldn't but some insurances require it. We used to bill it without the -25 and then if the office visit came back denied we would add it and get it reprocessed. It just depends on the insurance
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#3
03-07-2012, 09:57 PM
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Hello,
To my knowledge, modifier 25 can only be appended to E/M codes followed by another procedure code(not an E/M) to indicate that a separate evaluation and management service was done on the same day as the procedure. This is to avoid the carrier from bundling the office visit charges into the payment for the procedure. Modifier 26 is appended to radiology codes to reflect the providers interpretation and report in physician billing. If the provider is using the xray machine in his office, the question is does the xray equipment belong to the provider? If there is no one else who can bill the technical component of the xray (modifier TC) then the provider would bill the radiology code with no modifier, however, due to that fact that this is not the norm, he may have to be prepared to explain to the carrier that he can rightfully bill for both components. 
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