Wiki E/M modifier question

[bcgoodman64@gmail.com]

I know this sounds like a stupid question to everyone but I really need the answer on here so I can have proof.
Patient comes in for a sick visit - sore throat, strep test done in our office. Does the visit get a 25 modifier?
AND if there is an ADHD follow up visit with Vanderbilt forms. Does the visit still get the 25 modifier?
So basically does the E/M visit get the 25 modifier when other things are done?

 

[csperoni]

Labs should not require modifier -25 on the E&M service to receive payment. There is no E&M element built into lab testing. Mod -25 is needed on an E&M service when there is another procedure being performed. Items like minor procedures with 0 day global. A separate and distinct problem oriented visit the same day as a preventive visit.
I am not familiar with ADHD care or "Vanderbilt forms" and do not know how that is being coded and billed. If those services are coded with problem oriented E&M 99202-99215, then you cannot bill 2 visits. It would make your 1 visit more complex.
Notice my use of "SHOULD NOT". Over the years I have come across all sorts of ridiculous carrier policies like bundling an E&M with a lab procedure. So depending on what the other things done are, you may or may not require -25 per coding guidelines. And depending on carrier policy, even if coding guidelines do not require it, you may still need it.

 

[TThivierge]

Hi
Only get a 25 modifier on same line of Eva. Mgnt codes when lab, xrays or injections done during same day office visit as way to determine pt s illness or condition. Modifier 25 is not to be used for ADHD or depression or dementia questionnaires.
I hope helped you a bit more
Lady T

 

[amyjph]

https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00153948

If you are billing 96110 for the forms some payers may require a 25 modifier with the E/M even if there is no NCCI edit. Normally, you don't need it for 96110 with an E/M. Like Christine said, there can be weird payer rules that don't follow CPT or CMS and make their own crazy guidelines.
Agree, the labs for strep should not require it either.
This thread was ortho related but the links I added have information on modifier 25 use. https://www.aapc.com/discuss/threads/modifier-25.191367/?view=date#post-524481

Your proof shouldn't necessarily be from the forums because there can be a lot of incorrect information and opinions on here sometimes. It should be the definition of modifier 25 in your coding book (Appendix A), NCCI edits/manual, and payer specific guidelines (if any).