Wiki -25 for NP with procedure, single Dx

[hart65ley]

I am billing -25 on New Patient E/M's and New Patient Consults when the physician sees a patient for evaluation and decides in the same visit to perform a diagnostic laryngoscopy or nasopharyngoscopy. I often get bundling logic denials on the E/M when there is only one diagnosis.

Example:
99243-25
31575
Dx: 784.49

Can someone point me to coding logic I can reference in appeals for payment on the E/M charge?

 

[LLynn29]

There is a good article on E/M modifiers in the Coding Edge which explains the purpose of the 25 modifier. You can find it in the August 2012 edition, page 34. Hope that helps.!