Question Modifier 25 and 2021 E/M Guidelines

tg

Networker
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84
Location
Jackson, NJ
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It seems easier to add the modifier 25/bill a visit together with a minor procedure now that there are no specific requirements for history and exam. For example, if a patient had fungal toenails debrided and also had medication prescribed for the fungal toenails. In the past, we couldn't bill a visit and modifier 25 since there was no separate exam and history. Now if it is only based on medical decision making, why not?

Thank you for your help.
 

Deborah Marsh

Contributor
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11
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Hi - The office and outpatient E/M codes still include a medically appropriate history and exam, and procedures still include the related pre/post-op services (depending on what the global period includes). So proceeding with caution when deciding whether to use mod 25 seems like a good idea to make sure the documentation supports a separate E/M code (and if so which one) once the services paid under another code are excluded.
 

TWinsor

Guru
Messages
180
Location
Columbus, OH
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Looking for guidance for documentation to support using 25 modifier,especially with injections (new and est patients). With new documentation guidelines, if no other problems or issues are addressed, I am having difficulty supporting the 25.
 
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