Wiki Modifier 25 and X Rays in MD office Setting

pondrov@yahoo.com

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We've just been informed by BCBS we are appending Modifier 25 "too often".
The only way this would be happening is our outside billing company appending a 25 to x ray services.
We are an orthopedic group,routinely get x rays for new patient baseline evaluation as well as for established and post op patients and we do not append the modifier 25 to any x rays taken in office.(always taken at time of office visit and exam,never "just an x ray")
The more I read and research the verbiage around x rays and modifier 25,the more confused I get.
Can anyone please advise if and when a modifier 25 is to be appended to an E/M code where x rays were performed at the time of office visit?
Thanks in advance.
 
We've just been informed by BCBS we are appending Modifier 25 "too often".
The only way this would be happening is our outside billing company appending a 25 to x ray services.
We are an orthopedic group,routinely get x rays for new patient baseline evaluation as well as for established and post op patients and we do not append the modifier 25 to any x rays taken in office.(always taken at time of office visit and exam,never "just an x ray")
The more I read and research the verbiage around x rays and modifier 25,the more confused I get.
Can anyone please advise if and when a modifier 25 is to be appended to an E/M code where x rays were performed at the time of office visit?
Thanks in advance.
We do xrays in the office for Podiatry and we always add mod 25 to the E/M when xrays are done. The only time we don't is when it's a post op with xrays. Not sure why you would be told your appending "too often"
 
We do xrays in the office for Podiatry and we always add mod 25 to the E/M when xrays are done. The only time we don't is when it's a post op with xrays. Not sure why you would be told your appending "too often"
Thanks for your response.I'm in the process of auditing all the charts with 25 modifiers to see if I can find anything outside of the norm.
 
I bill for podiatry and since 2008, I've never used a 25 modifier on an office visit with only an x-ray which is a diagnostic; (25 modifier indicates a separately identifiable exam when a procedure is preformed). IMO it is not warranted and I've not ran into any payer who requires that here in Georgia.
 
I just received a call from Health Net requesting return reimbursement because they stated that a 25 modifier was required for an office visit with x-rays. I also work in orthopedics where we routinely bill office visits with x-rays, and we have never appended a 25 modifier. I told the representative that an x-ray was a separate procedure, not a part of the office visit. I've worked for this clinic for 2 years, and I've never heard of any denials for this reason. She said she would look into it further.
 
I just received a call from Health Net requesting return reimbursement because they stated that a 25 modifier was required for an office visit with x-rays. I also work in orthopedics where we routinely bill office visits with x-rays, and we have never appended a 25 modifier. I told the representative that an x-ray was a separate procedure, not a part of the office visit. I've worked for this clinic for 2 years, and I've never heard of any denials for this reason. She said she would look into it further.
I am researching this topic for our clinic, did you get any response from the insurance regarding the takeback? Can anyone please help with the following scenario - Office visit and x-rays done on the same day in a physician office setting:
1. Can we bill separate claims for office visit and x-rays since they are different services? Or they have to be billed together on the same claim?
2. Do we need to append 25 modifier on the office visit claim in each case - 2 separate claims vs single claim with ov + x-rays?
 
I am researching this topic for our clinic, did you get any response from the insurance regarding the takeback? Can anyone please help with the following scenario - Office visit and x-rays done on the same day in a physician office setting:
1. Can we bill separate claims for office visit and x-rays since they are different services? Or they have to be billed together on the same claim?
2. Do we need to append 25 modifier on the office visit claim in each case - 2 separate claims vs single claim with ov + x-rays?

A Modifier 25 is used to override an NCCI edit. If there's no NCCI edit between the office visit and the xray code, there's no reason to append a Modifier 25 to the E/M service.
 
A Modifier 25 is used to override an NCCI edit. If there's no NCCI edit between the office visit and the xray code, there's no reason to append a Modifier 25 to the E/M service.
I agree. The E/M instructions are clear that tests for which the physician is reporting a code for the interpretation and report do not count toward the amount and/or complexity of data to be reviewed and analyzed so there is no overlap of the E/M and the interpretation and report of the x-ray. If the payer has written policy requiring modifier 25, it would be of value to seek a revision to the policy with potential assistance of the state medical association or state chapter of a specialty organization.

Cindy
 
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