Wiki e/m and xray

[dalanicks@aol.com]

the new office I work in are putting modifier 25 on all office visits with xrays, is that necessary?
please help

 

[philipwells]

Negative, it's not necessary. Here's the best way I can remember it. E&M's with x-rays ie 70000 series codes will not need a 25 modifier on the E&M. The same is for the laboratory CPTs ie 80000 series codes. Insurance considers these always separate. Below situations would be billed as so. Now when we bill an E&M with 90000, J-codes, and minor surgeries ie 10000-20000 series codes we would bill with a 25 modifier, assuming they were under the 10 day global.

99213
81002
81025

99213
73562

99213-25
j0702
20610

If someone would like to refine/correct my rationale with article reciting that would be great, thanks!

 

[dalanicks@aol.com]

thank you!

 

[stephanie7480]

There is no NCCI edits to warrant the use of -25;however, you may find that there are some payers that want it to be appended.