Wiki E/M, Preventative, Injection

[rhiannonmcnz]

Hello everyone,

I am curious as to whether or not the following is correct. I coded...
99204-25
99386-25
90471
90656
I have a fellow coworker who is a biller questioning as to why I added the -25 to the office visit as well as to the preventative. I told her I added the -25 to the office visit to separate it from the preventative. As well as added the -25 to the preventative to separate it from the injection. She is thinking this is incorrect. I have done some research and couldn't find any definitive answers as to why both the E/M and the annual get -25 modifiers when there is an injection on the claim as well. I am just trying to find a resource that explains this. If anyone has any info it would be greatly appreciated.

Thank you

 

[sls314]

Hello everyone,

I am curious as to whether or not the following is correct. I coded...
99204-25
99386-25
90471
90656
I have a fellow coworker who is a biller questioning as to why I added the -25 to the office visit as well as to the preventative. I told her I added the -25 to the office visit to separate it from the preventative. As well as added the -25 to the preventative to separate it from the injection. She is thinking this is incorrect. I have done some research and couldn't find any definitive answers as to why both the E/M and the annual get -25 modifiers when there is an injection on the claim as well. I am just trying to find a resource that explains this. If anyone has any info it would be greatly appreciated.

Thank you

The first thing I'll ask is why both the 99204 and the 99386.

Does the documentation truly support a distinct medically necessary new patient office visit in addition to the initial preventative visit?

 

[rhiannonmcnz]

The first thing I'll ask is why both the 99204 and the 99386.

Does the documentation truly support a distinct medically necessary new patient office visit in addition to the initial preventative visit?

I believe so yes. The patient is being treated for a chronic illness as well as having a medication dose increased. That is why I appended the 99204 as well as the 99386.