25 modifier

  1. P

    Wiki E/M service denied with 25 mod but procedures paid

    I bill for a PCP office and we always bill 99213-25 and 96372 with a med. The injection has been getting paid and the OV has been getting denied for included or bundled with the 25 mod and distinct diagnoses... I have had this happen A MILLION times with Humana, Aetna, HAP, BCBS, and Molina. Has...
  2. A

    Wiki Seperatly Identifiable

    We have an encounter that our offices coders dissagree on. We did a procedure after an Office visit. One says because the pt came in for an Office visit and the "decision for surgery" (no global period for this procedure) we should bill the Office visit with a -25 modifier. Another says the work...
    • Aflory5
    • Thread
    • 25 modifier e/m
    • Replies: 0
    • Forum: E/M
  3. C

    Wiki 25 Modifier ONLY to be appended by certified coder?

    Hello! I am a CPC for the department OBGYN for a large medical group. just spoke with a member of management from the central billing office at my place of work, and they requested that I advise our billers that they may not append the modifier 25 to any office visit if they are not coders. I...
    • CShipitz
    • Thread
    • 25 modifier coder modifier modifier 25 modifiers
    • Replies: 7
    • Forum: Modifiers
  4. M

    Wiki BCBS denying E/M codes with 25 modifier

    I do billing for five different practices across Texas and am having an issue with BCBS. They are denying most E/M codes when we use the 25-modifier (to distinguish from other services rendered the same day). I've gotten dozens of these so far. I have read some info online from different...
  5. K

    Wiki E/M with a 25 when doing an injection?

    Hello, I am fairly new to orthopedic coding and our docs do a lot of injections! I am struggling with when it is okay to bill an office visit with the 25 modifier. The guidelines that I was told to go by was that we always bill a new patient (99202-99204) with the 25 when an injection is...
    • Katie_Ellis
    • Thread
    • 25 modifier bill established patient injection office visit
    • Replies: 2
    • Forum: E/M
  6. N

    Wiki I&d w/ e/m?

    So I have a provider who performed a full E/M on a lesion, concluded it was an abscess and performed an I&D and gave an antibiotic perscription. My question is would this be an E/M-25 w/ 10060 OR because the E/M was directed towards the abscess would this just be a 10060? Its the wording...
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