25 modifier with e/m and x-ray

NFBarner

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Hi, I'd just like an opinion on the use of the 25 modifier when coding for an E/M visit and an x-ray was also reviewed by the doctor. I have always added a 25 modifier to the E/M code when billing for the professional component of the x-ray. This is an office setting. Thanks for your help.
 

ollielooya

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It's my understanding that the x-ray review by the doctor is considered part of the acquirement of DATA to determine the level of decision making which affects EM assignment. Based on your above description, modifier 25 would not be added to the EM visit, as it would already have been included in calculation of the MDM process.

Others care to comment?
 

abishard

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Hi, I'd just like an opinion on the use of the 25 modifier when coding for an E/M visit and an x-ray was also reviewed by the doctor. I have always added a 25 modifier to the E/M code when billing for the professional component of the x-ray. This is an office setting. Thanks for your help.
Is the physician providing the official interpretation of the x-ray or is he just performing an over-read? If he is providing the official interpretation, the documentation needs to include a written report of the interpretation. The 25 modifier is not appropriate on the E/M code as the professional interpretation is billed and paid separately. I know some insurances want documentation of the written report and E/M.

If your physician is providing anoverread, then Ollielooya is correct as it is included in the E/M and not separately billable.
 

scooter1

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I don't believe the 25 modifier is necessary in this situation. We do not use the 25 modifier for that.
 

melzinser

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do you bill global x-ray fee?

For in-house x-rays, we bill the global charge. We own the equipment and our providers are required to dictate an interpretation of the exam as a separate report or a distinct section of their encounter documentation. No modifier is necessary.

If a patient brings outside imaging for review, that "work" is included in the MDM of the E/M code and so wouldn't be separately billable.
 

monica@hands

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we use a 25 when the physician performs fluoroscopy day of the exam and we are billing an E/M and a fluoro code.
 

karinquiterio

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I realize this is an old forum but we are currently being told that we must add modifier 25 to our e/m code when we own the x-ray machine, employ the radiologist, and our doctor reads/dictates the xrays in note per AMA guidelines? We have NEVER done this before.
 
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