Wiki 9939x & 96372

[arrana]

Can modifier 25 be attached to a wellness exam code such as 9939x when another procedure is done at the same time, for example but not limited to, a 96372 therapeutic injection?

In other words, is this valid coding:
9939x - 25
96372

Thanks,
Arrana
AR Representative
Outer Cape Health Services
Wellfleet, MA

 

[kathyseyfried]

Modifier -25

Modifier -25 is never appended to preventive service codes. It is only to be appended to the problem-oriented E & M code (office/OPD=99201-99215).

Re: 96372 - this is an injection code and, usually, you bill the drug as well (HCPCS code). Are you using 96372 for a vaccine administration? If so, you are using the incorrect code - it should 9047x and the appropriate vaccine code.

You might ask the doctor, or review the documentation, for the reason the 96372 (non-vaccine injection) was given. Was there a significant, separately identifiable problem oriented E& M service that day resulting in the need for the injection?

 

[OCD_coder]

I must strongly disagree with that advice, a preventative service IS an E&M. It's in the E&M section of the CPT book and in the preventative medicine family of codes and you will need a modifier 25 appended when ever you have a minor procedure with a global period of 0-10 days, such as the 96372 code on the same DOS as an E&M.

This the message that comes up in 3M and similarly in Optimum when you run a edit check:
"A CPT procedure has been coded along with an E&M (evaluation and management) code. If this is a significant, separately identifiable E/M service by the same physician on the same day, then modifier -25 should be added to the E/M code"