Wiki 59 modifier use

[vinmadhu]

i would like to know can we use modifier 59 for E/m code 25 with flu vaccine?

 

[LeslieJ]

Modifiers are used only in the case when 2 or more CPT codes are considered inclusive to each other.

The best way (and free) to find out if 2 codes are bundled, is to check the NCCI Edits, where column 2 CPT is considered a part/inclusive to/bundled with the code in column 1.

Some modifiers are for use only with an E/M service.
Others are only for use with surgical CPT codes.
Just because you can add a modifier, doesn't mean that you should.

Modifier 25, for example, is used with the E/M service when there is a separately identifiable exam with a procedure. Remember that every procedure has a precursory exam that is included with the procedure, so use modifier 25 if the documentation shows an exam that goes above & beyond the reason for the injection.

Based only on what you wrote I see no reason to add modifier 59.

Please be sure to read the NCCI Policy Manual found here: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html?redirect=/NationalCorrectCodInitEd/. There are several items in the "downloads section" if you'll scroll down on this page that are worth the read.

L J