Wiki Modifer 25 with annual exam

[gigi2266]

NP annual exam comes to the office for gyn. Pt has annual but also has other issues. Physician documents properly and 25 modifer is placed on the E&M. Is it correct coding that the E&M used with the modifier should be an established E&M code with a new patient annual exam code?

 

[Lisa Bledsoe]

That is my interpretation, but others on the forum state both can be new. It really will depend on the carrier.

 

[capecoder6]

modifier 25

We have been billing a 25 modifier on the E&M along with a physical and we do receive payment. There are very few insurance companys that are not paying.