25 mod

libraden

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I do some coding for fpr offices and my understanding of the 25 mod is that it has to be seperately identifiable, my doctors will use a destruction of benign lesion code 17110 and a 99212 and put a 25 on the e&m when they are using the same dx. the pt came in for the same thing all around, isn't it right to not bill for the 99212 with the 17110 if they have the same dx?
 
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mitchellde

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You do not need a separate dx to use the 25 modifier only the documentation to support an assessment is over above and beyond what is necessary for the procedure. Every procedure has a component the assessment necessary to perform all elements of the procedure. So a lesion excision needs to have an examination of the affected area in question .. if that is all you have then no visit level, if the documentation goes further to describe say a full body exam then you would have the rationale for a visit with the 25 modifier even though you have only 1 dx code.
 
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