Wiki Modifier 25 and OMT Codes

[Bugsy]

Hi,

I need some clarification on whether or not modifier 25 is always appended to E/M codes when billed with OMT codes. I'm a fairly new coder and my manager isn't sure what the rule is. I thought it was but maybe that's not the case...

 

[Pam Warren]

Anytime someone suggests "always", a big alarm bell should go off in your head! Every patient and scenario is different. E&M services billed with minor procedures are typically bundled into the procedure per CCI edits, unless the E&M fully documents a significant and separately identifiable service outside what would normally be evaluated prior to performing OMT. You'll have to collaborate with your provider to find out what that documentation would look like. Then if additional documentation pertaining to increased work or evaluation, or a different problem or condition exists, you can bill out the E&M, considering only that additional work and not anything that would be considered the typical pre-OMT evaluation. If the patient is already scheduled for OMT, you can be sure that the evaluation and decision for the procedure has already been done, and the cursory examination done at that time is going to be bundled into the OMT.

 

[Bugsy]

Hi Pam,

Thank you so much for your reply! I found it very helpful and informative!

- Amanda (a.k.a Bugsy)