Wiki Mod 25

[dpumford]

Hello:

If a patient is in the hospital and the doctor bills for a subsequent care day on the same day he reads a echo & TM . Do you need to add mod 25 on the care day to get it paid?

I don't think you do because it is a diagnostic test. I don't ever remember addding mod 25 when I was a biller on care days when a test is also read by the same physician on the same day.

A biller I know was told to do this and I am not sure that this is correct and now I need to figure this out but nothing I find really give me a straight answer...So any input would be greatly appreciated.

Thank you so much!

 

[stephanie7480]

Hello:

If a patient is in the hospital and the doctor bills for a subsequent care day on the same day he reads a echo & TM . Do you need to add mod 25 on the care day to get it paid?

I don't think you do because it is a diagnostic test. I don't ever remember addding mod 25 when I was a biller on care days when a test is also read by the same physician on the same day.

A biller I know was told to do this and I am not sure that this is correct and now I need to figure this out but nothing I find really give me a straight answer...So any input would be greatly appreciated.

Thank you so much!

Per my coworker this is how she bills care day with a 25 and add a 26 mod to the echo

 

[terribrown]

My simplified rationale to understanding modifier 25 in short is: If the service (CPT code) was DIAGNOSTIC (required for the physical exam and/or MDM of the CC), then no modifier 25 is needed on the E/M code. If the service (CPT code) was actually TREATING the condition diagnosed, then modifier 25 is needed on the E/M code.

To the experts out there, am I on the right track or way off?