Wiki -25 Modifier

[akmorgan]

A patient comes in the office with back pain, the physician evaluates the patient and decides to do an injection for the pain. Can the physician bill an E/M with a -25 modifier and the injection even though the only diagnosis for the visit is back pain.

Thank you.

 

[btadlock1]

A patient comes in the office with back pain, the physician evaluates the patient and decides to do an injection for the pain. Can the physician bill an E/M with a -25 modifier and the injection even though the only diagnosis for the visit is back pain.

Thank you.

Yes. It doesn't have to be a different diagnosis - he evaluated the problem, and made a decision on how to treat it, so an E/M is justified. Now, if he told the patient, "Come back tomorrow and get an injection.", you wouldn't be able to bill a separate E/M the next day, because all of the E/M work occurred on the day before. If the work's documented, then you can bill the code.

 

[MTrujillo]

Hello Brandi, for the above answer, would/could you add modifier 59 to the injection or would you let it stand alone?
Thanks, Mysti

 

[btadlock1]

Hello Brandi, for the above answer, would/could you add modifier 59 to the injection or would you let it stand alone?
Thanks, Mysti

AS long as it's just the injection and E/M, then no. Now, if some other procedure was done, like a trigger point injection, then you would need a 59 on the admin. But the -25 modifier on the E/M should take care of the injection admin and E/M bundle.