Wiki Billing Modifiers 24 and 25 Together?

[nicoleysmith]

We have a patient who had a skin lesion removed. Then the patient came in within that global period for an office visit separate from the skin lesion removal. During this office visit, the patient had an EKG performed. The patient's insurance, Medicare, considers an office visit performed on the same day as an EKG as bundled with the EKG so we have been adding the -25 to show other issues were addressed besides the EKG. Do we need both modifiers -24 and -25 on the office visit? Or is just -24 enough?

99214-24-25
93000

or

99214-24
93000

or

99214-25-24
93000

Please and thank you!

 

[shanamarie]

We have a patient who had a skin lesion removed. Then the patient came in within that global period for an office visit separate from the skin lesion removal. During this office visit, the patient had an EKG performed. The patient's insurance, Medicare, considers an office visit performed on the same day as an EKG as bundled with the EKG so we have been adding the -25 to show other issues were addressed besides the EKG. Do we need both modifiers -24 and -25 on the office visit? Or is just -24 enough?

99214-24-25
93000

or

99214-24
93000

or

99214-25-24
93000

Please and thank you!

I believe you would need both modifiers since they are specifying different things. 24 for global period and 25 to unbundle the ekg. I’m not certain on which order the modifiers need to go though.

 

[b.cobuzzi]

I agree with shanamarie. I would put the 24 modifier first because you need to break the global first, to even get the payer look at the claim and then you put the 25 so they will look at the em and the ekg.

 

[nicoleysmith]

Thank you very much!

 

[petroskek]

You shouldn't need a -25 modifier on an E/M with an EKG, unless your payer has specified otherwise. We bill FCSO and don't use the -25. In this instance, I would only use -24 modifier.

https://med.noridianmedicare.com/web/jeb/topics/modifiers/25

https://www.supercoder.com/coding-newsletters/my-primary-care-coding-alert/reader-questions-dont-assume-em-with-ecg-requires-25-article

 

[Faith@032413]

First append 24 modifier - for separate skin lesion in GLOBAL PERIOD.
Second append 25 modifier-for EKG performed.

99214-24-25
93000