Wiki Mod 25

[apollo06]

I may be overthinking this- I know Mod 25 is to be used for a seperate-significantly idenitifiable service and goes on E/M. However, I am confused as to the global piece of it when there are NO global days to a service such as a administration code 96372.
Pt comes in for a depo injection however, the provider addresses, acne, asthma. Would a mod 25 be appropriate in this case?:confused
thank you for your feedback

 

[Tammym91]

25 modifier

Yes, the 25 modifier would be aaplicable on the E&M if problems were discussed separately from the reason for the injection.

25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional 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. 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.

 

[OCD_coder]

Just an FYI, the 96372 code has a status indicator of XXX (not 0) which means the modifier 25 global rules concept does not apply. A modifier 25 is still appended to the E&M level.

Source:CMS NCCI Coding Manual, Chapt 1, General Policies
Procedures with a global surgery indicator of ?XXX? are not covered by these rules. Many of these ?XXX? procedures are performed by physicians and have inherent pre-procedure, intra-procedure, and post-procedure work usually performed each time the procedure is completed. This work should never be reported as a separate E&M code. Other ?XXX? procedures are not usually performed by a physician and have no physician work relative value units associated with them. A physician should never report a separate E&M code with these procedures for the supervision of others performing the procedure or for the interpretation of the procedure. which may be reported by appending modifier 25 to the E&M code.

This E&M service may be related to the same diagnosis necessitating performance of the ?XXX? procedure but cannot include any work inherent in the ?XXX? procedure, supervision of others performing the ?XXX? procedure, or time for interpreting the result of the ?XXX? procedure. Appending modifier 25 to a significant, separately identifiable E&M service when performed on the same date of service as an ?XXX? procedure is correct coding.