Wiki Modifier 25 - increased audits

[ediepierre]

Okay, I've seen the notices about using modifier 25 and how the audits will increase. I want to make sure the way we are billing is correct (we have not gotten denials...yet). I work for a pain clinic and our patients come in monthly. Some get injections, some do not and some get smoking counseling etc... Is modifier 25 acceptable to use for a patient that comes in and gets injections or counseling under CPT code 99213/99214?
eg...

99214, 25
20552
96372, 59 x 3
J1885
J1100
S0020
80176

or

99213, 25
99406

Any help would be great! Thanks! (ps...ignore numbers on injections, just by memory so they may not be right...just an example)

 

[mitchellde]

if the purpose of the encounter is a scheduled injection then no you cannot bill the E&M with a 25 modifier. The same is true of the counseling.

 

[ediepierre]

The patients come monthly to evaluate their pain and get their prescriptions. Some of these come in and their pain levels are high so the decision is made to give injections at that point. As for the counseling, do I just bill a 99213 and a 99406 with no modifiers?