Wiki I&D and OV with mod 25

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loryanned

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I had a new patient come in the practice yesterday. She was seen for approx 30 minutes for an abcess on her buttocks before Dr. made the decision to I&D. Can I bill for both the OV and the I&D with a modifier 25?
 
also FYI

Just an FYI, if you look at all the headings listed on this website you will see that down lower there is a "Medical Coding" heading and different sub-headings. Posting your questions there according to category will get more readership and possibly more/faster responses to your questions.
 
would be appropriate but you need to code the ov with the symptom .... and the 25 but there is really ggod chance that they will not pay it because they will not pay for a procedure and ov on same day with same dx.... if they came in for something else then they will pay both
 
chelebell59 said:
would be appropriate but you need to code the ov with the symptom .... and the 25 but there is really ggod chance that they will not pay it because they will not pay for a procedure and ov on same day with same dx.... if they came in for something else then they will pay both
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Not necessarily true. Some carriers may have edits in place for this but a different DX is not required per CPT and MCR guidelines.

B. CPT Modifier “-25” - Significant Evaluation and Management Service by Same Physician on Date of Global Procedure

Medicare requires that Current Procedural Terminology (CPT) modifier -25 should only be used on claims for evaluation and management (E/M) services, and only when these services are provided by the same physician (or same qualified nonphysician practitioner) to the same patient on the same day as another procedure or other service. Carriers pay for an E/M service provided on the day of a procedure with a global fee period if the physician indicates that the service is for a significant, separately identifiable E/M service that is above and beyond the usual pre- and post-operative work of the procedure. Different diagnoses are not required for reporting the E/M service on the same date as the procedure or other service. Modifier -25 is added to the E/M code on the claim.

-Chpt 12 of the Medicare Manual-
 
-57

Rebecca would you please explain why you feel the -57 is inappropriate?

At the bottom of the -25 explanation the note states: This modifier is not used to report an E/M service that resulted in a decisionn to perform surgery. See modifier 57.

-57 Decision for surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service.

Incision and Drainage is a surgery is it not?

Thanks for your input.
 
lphillips said:
Rebecca would you please explain why you feel the -57 is inappropriate?

At the bottom of the -25 explanation the note states: This modifier is not used to report an E/M service that resulted in a decisionn to perform surgery. See modifier 57.

-57 Decision for surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service.

Incision and Drainage is a surgery is it not?

Thanks for your input.
Click to expand...

Modifier 57 is not used with minor surgeries. Modifier 57 is used for those procedures designated as a "major surgery" (i.e. 90 day post op); decision to perform surgery day of or day before surgery (designated as major surgery). Modifier 25 is used for those procedures designated as a minor surgery (i.e. 10 days). In the original post, an I&D was referenced which normally carries a 10 day global period.
 
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