Wiki Modifier -25 - auditing claims

[jennyaharvey]

I am auditing claims on behalf of an attorney who is trying to determine if his client was charged correctly for medical expenses as the result of an MVA. The patient was seen by a spine specialist who performed spinal injections on several occasions. The office billed 99123-25 along with the codes for the injections for several DOS. The E/M only mentioned the back pain and nothing else was examined/discussed. How do you determine if a separate E/M was warranted? CPT Assistant states that having a separate diagnosis is not needed in order to use modifier -25. Confusing much?



Thanks for your help with this.

 

[MCJCCH]

What I would suggest is going to this website < https://www.novitas-solutions.com/em/pdf/scoresheets/8985.pdf > and using the E/M audit tool worksheet to figure out if a new E/M code is accurate. I use a scoresheet similar to this as needed but mine was given to me by my professor years ago so I am unable to figure out where she got it from. Hope this helps!!