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Wiki 25 modifier

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umas86

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Hi all,

I need a clarification regarding billing the EM with 25 modifier along with minor procedure. I work for urology providers, they plan for a minor procedure like cystocopy in the initial visit. The f/u visit is marked as procedure visit but after the procedure description, he provides a template note like " NOTE: A separate office visit was done after the cystoscopy counseling patient on evaluation of LUTS withcystoscopy and urine culture and urinalysis and management options for LUTS, including behavioral modifications(e.g reduction of caffeine intake), medications (e.g. Myrbetriq), botox injection in the bladder, and PTNS."

Can this note be considered to bill for seperate EM CPT like 99213 or 99214 OR this qualifies only for a procedure visit and only procedure should be billed.

Please advise. Thank you in Advance
 
A good guideline for figuring out if you need -25 is "if I took away everything related to the procedure and the reason for the procedure, would I have enough left for an office visit?" In this case, no. The education all related to the cystoscopy and management of the condition that is being treated (the LUTS.) There isn't "separate and significant" work done related to another condition.
 
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