Wiki code 12031

NOTAQUITTER

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If we have three codes for services that the same physician has done on the same day as follow;
99284,25605 and 12031

and we want to report 12031(laceration) as an additional procedure, should we use modifier 25 with code 99284 and report it as an additional EM service or;
Should we use modifier 51 with code 25605 and consider it as an additional procedure?

It seems it should be a procedure rather that EM service, but I have read in a test book that they have assigned modifier 25 to it and considered it as an additional E/M service. I have found it really confusing and it would be great if somebody could give guidance on this.
Thanks
 
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If we have three codes for services that the same physician has done on the same day as follow;
99284,25605 and 12031

and we want to report 12031(laceration) as an additional procedure, should we use modifier 25 with code 99284 and report it as an additional EM service or;
Should we use modifier 51 with code 25605 and consider it as an additional procedure?

It seems it should be a procedure rather that EM service, but I have read in a test book that they have assigned modifier 25 to it and considered it as an additional E/M service. I have found it really confusing and it would be great if somebody could give guidance on this.
Thanks
If we have three codes for services that the same physician has done on the same day as follow;
99284,25605 and 12031

If we have three codes for services that the same physician has done on the same day as follow;
99284,25605 and 12031

and we want to report 12031(laceration) as an additional procedure, should we use modifier 25 with code 99284 and report it as an additional EM service or;
Should we use modifier 51 with code 25605 and consider it as an additional procedure?

It seems it should be a procedure rather that EM service, but I have read in a test book that they have assigned modifier 25 to it and considered it as an additional E/M service. I have found it really confusing and it would be great if somebody could give guidance on this.
Thanks
 
Modifier 25 on the E&M, if distinct and separately identifiable.

NCCI Edit Results:
Edit exists with 25605. 12031 is a Column 2 code. If both 25605 and 12031 are submitted, only 25605 will be paid.
- Modifiers associated with the CCI ARE allowed with this code pair WHEN APPROPRIATE.
- Rationale: Misuse of column two code with column one code

Laceration repairs are bundled into the surgical procedure. If its a repair unrelated to the fracture care then you can add modifier 59 to 12031 to attest that its distinct. Possibly XS for separate structure instead of 59 depending in the payer. Example that would qualify for the modifier would be say patient had head laceration from the fall that caused the fracture. It cannot be billed if its closure for the fracture area.
 
Modifier 25 on the E&M, if distinct and separately identifiable.



Laceration repairs are bundled into the surgical procedure. If its a repair unrelated to the fracture care then you can add modifier 59 to 12031 to attest that its distinct. Possibly XS for separate structure instead of 59 depending in the payer. Example that would qualify for the modifier would be say patient had head laceration from the fall that caused the fracture. It cannot be billed if its closure for the fracture area.

Thanks a lot. It really helped to resolve my issue. In fact, the repair was related to the fracture itself so they assigned a wrong modifier to a wrong code! and it seems I am going to learn from their mistakes from now on.
 
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