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Management options/MDM


Chesilhurst, NJ
Best answers
Good morning,

My question is in regards to management options. If a provider bills 99214 with modifier 25 along with strapping and physical therapy modalities, should he receive credit for the strapping and modalities within the management options of the E/M?
My thought is that the provider is billing with modifier 25 stating that it is separate and distinct from the modalities/strapping and these should not be used to increase the MDM for the office visit. Any thoughts would be greatly appreciated.

Thank you,
Best answers
I agree, as long as they use a 25 modifier. The modifier is Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service). The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service. Yes they can bill the modalities and the office visit as long as they can stand alone.