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E&M vs modifier 25

S

Sandra Fender

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PT came in the office for bursitis, and durning the visit complained of ear drainage so an ear irrigation was done. Now from what I have been told, the mod 25 goes on the procedure, now from what I am reading it goes on the E&M code. Can anyone plz confirm this for me. I am haveing the same problem with Asp/Inj as well.
Thanks
 
The 25 is always appended to the E/M code.

Please be sure you are confident the irrigation is separately billable and not included in the E/M (even though it's a separate issue). It's my understanding that irrigation alone (without impaction and instrumentation) is not separately billable.
 
Modifier 25

Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician* on the day of a procedure. Use Modifier 25 with the appropriate level of E/M service. If you put modifier 25 anywhere but the E/M CPT code, it will not pay.
 
suznoland1146 said:
I have always been told that Mod-25 NEVER goes on an E/M code.
Click to expand...

It is unfortunate that you were badly misinformed on this issue! When you say "always" it scares me a little bit that you have "always" been instructed so badly. Please feel free to obtain clarification from this forum anytime you have a question.
 
E&M Visit and Modifier 25

Sandra Fender said:
PT came in the office for bursitis, and durning the visit complained of ear drainage so an ear irrigation was done. Now from what I have been told, the mod 25 goes on the procedure, now from what I am reading it goes on the E&M code. Can anyone plz confirm this for me. I am haveing the same problem with Asp/Inj as well.
Thanks
Click to expand...
:cool:

Hi, Sandra...
Good Question.....
If suppose E/M visit is there and physician perform same day procedure we need to append 25 modifier. In your question there you will append 25 modifier with E/M CPT code.
 
Modifier 25

btotten said:
do you have the resource you've obtained this information from?
Click to expand...

Hi,

If you have a CPT manual published by the AMA, look at the description of the modifiers (usually Appendix A). Toward the end of the description of modifier 25, you will see "This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service..." This is the official guideline for the modifier and you can likely find this in Medicare and other health plan policies on the modifier as well.

Also to the original question, see code 69209 for removal of impacted cerumen using irrigation/lavage. Payer policies may vary on whether reporting as a bilateral service is allowed and/or whether the service is separately paid on the same date as an E/M service.

Hope that helps.

Cindy
 
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