Wiki modifier -25 and radiology

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ercoder65

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If performing an E/M in the office, and taking an xray of a patient, are you still inclined to append the 25 modifier to the E/M? I have been given conflicting answers on this question. I assumed an xray was considered a "procedure or service". Is there definitive articles on this subject? Thanks in advance.

Rich
 
25 mod

Modifier 25 is used to identify a significant, separately identifiable evaluation and management service performed on the same day as another procedure or service by the same provider.
 
25 modifier is not required for Radiology & Laboratory services. I think it is because they don't have pre or post op components and they are not considered a procedure. My rule of thumb is if it comes out of the surgery section of the CPT book I need a modifier for my OV.
 
Breezy,

Thanks for the info. Have you ever gotten a denial because a -25 had not been appended to an E/M on the same day as an xray?


Rich
 
I agree with Wendy. We have a vascular lab in our practice. Many times the patient sees the doctor first and then he decides to send them to the vas lab for a scan or ultrasound. We have never put a 25 on the OV and have never been told we need to.
 
-25 modifier

The -25 modifier is used to identify a significant, separately identifiable E/M service when another service/procedure is performed on the same date, by the same physician.

If you are "sending the patient for an MRI" I would guess that you are not performing the MRI yourself, so no -25 modifier is needed on the OV.

F Tessa Bartels, CPC, CEMC
 
mri

Thanks Tessa,
We have been debating at the office over the use of the modifier 25. I have been looking for material on the subject to try and resolve our inconsistenices when using this modifier. We are also dealing with the modifier 57 too. I have read the guidelines and can see how different people can interpet it so differently. We are now trying to understand the incident to stuff. Crazy crazy days ahead.

Rich
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