Wiki 2 E&M's w/ mod 25

[kattekatt]

My manager belongs to a managers list serve thru a local hosp and there is talk on it that they are doing the following and getting paid for it:

99391-25 V20.2
99213 382.2

I always thought that the modifer 25 goes on the "sick code" - which way is the proper way to code- we have been coding it the other way.

Thanks for you help in advance
Kathy

 

[dmaec]

I agree with you Kathy - I would have it reversed -
99213.25 - 382.2
99391 - V20.2
(documentation supporting BOTH services of course)

{that's my opinion on the posted matter}

 

[RebeccaWoodward*]

I have copied this directly from UHC's website. Mod 25 does go on the problem oriented E/M code.

"A Preventive Medicine CPT or HCPCS code (99381-99397, G0344) and a problem-oriented E/M CPT code from the following code series only--99201-99205, 99212-99215--may both be submitted for the same patient by the same specialty physician or other health care professional on the same date of service. If the E/M code represents a significant, separately identifiable service and is submitted with modifier 25 appended, UnitedHealthcare will reimburse the Preventive Medicine code plus 50% of the problem-oriented E/M code. UnitedHealthcare will not reimburse a problem-oriented E/M code that does not represent a significant, separately identifiable service and that is not submitted with modifier 25 appended."