I'm having trouble with the 25 modifier. I'm being told certain codes are included in an E&M, such as a blood draw 36415, And not to append a modifier 25. In the past I've had whole claims denied for not adding a 25 modifier so this would indicate that I should only code the E&M? I was taught if a service/procedure was done, it should be coded. If this is the case, how would I code this visit? Would it be coded with an E&M only?
I've also had immunizations with E&M denied unless a 25 mod is used (for example in a case of well child visit), but I'm now being told I don't have to use the 25 modifer.
If a patient comes in for a sore throat and the provider does a full hpi & exam, takes a strep test and determines it is strep and gives a penicillin injection, what would I code? Should I only code the injection w/o the E&M? or the E&M with out the injection? How about the rapid strep test? Is that included in the E&M?
So I guess my question is, what IS and IS NOT included in the E&M?
I appreciate any insight you can give me, thank you.
I've also had immunizations with E&M denied unless a 25 mod is used (for example in a case of well child visit), but I'm now being told I don't have to use the 25 modifer.
If a patient comes in for a sore throat and the provider does a full hpi & exam, takes a strep test and determines it is strep and gives a penicillin injection, what would I code? Should I only code the injection w/o the E&M? or the E&M with out the injection? How about the rapid strep test? Is that included in the E&M?
So I guess my question is, what IS and IS NOT included in the E&M?
I appreciate any insight you can give me, thank you.