Wiki Modifier 25

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I am a student working on a presentation regarding modifier 25 and can't find an answer.

Is modifier 25 required for a new patient E/M with a same day procedure?

If you have any other interesting things about modifier 25 please let me know!

Thanks!
 
Hello Pamela,
Thanks for your query if we bill any E/M code with procedure ,so we need to append modifier-25 with E/M visit.
Mod-25 is indicate that the other service is given with E/M visit on same day...

Significantly identifiable e/m service by same physician or other qualified healthcare provider on same day..

Thank you..
 
Also of note: modifier 25 is for when a separately identifiable E/M is done same day as a minor procedure (0 or 10 day global), but modifier 57 is for an E/M on same day or day before a major procedure (90 day global). Use of the wrong modifier will result in a bundling denial.
 
Modifier 25 is not only for new patient coders, it applies pretty much to both, new and established.

Remember modifier 25 is pretty much stating a procedure differently from the office visit purpose was performed.

Example - Patient comes in for follow-up on medications. They checked and adjusted patient's HTN, DM and HLD meds. Patient was found to have a some keloid lesion on back, physican performs procedure to remove it.

The patient was not here for removal of a keloid lesion, is not related to the E/M (which was the visit for med adjustment).

So this would be coded with the appropriate office visit code, with modifier 25 and the procedure code for the keloid removal.

hope this helps!
 
I have a question re: 25 modifier. Here's the scenario:

Pacemaker clinic
99212- E/M
93280- Pacemaker interrogation (technical component only)
93005- EKG

We are billing the technical component only of 93280. The physician will always do an EKG and the office visit. Should any modifiers be added besides the 93280-TC? We are a critical access hospital not billing for professional fees in this case. Can anyone shed light? I'm questioning the use of 25 because the services are related.
 
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