Wiki modifier 25 - double check but

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ebredehoeft

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I just want to double check but it is my understanding that modifier 25 can only be put on the E/M code and not the other codes billed with the E/M code. I have a clinic that is putting 25 modifier on all but the e/m code. So I want to make sure I am telling them correctly.

Thanks:p
 
You are absolutely correct. The 25 modifier states that there is a seperately identifiable E/M with a surgical procedure.

There are instances where a 25 modifier is appended to another E/M code. Fore example when a patient is inpatient status and is seen in the am by the hospitalist then goes critical later in the afternoon. You would bill this incidence like this:

99233-25
99291

But, you cannot bill a followup inpatient CPT code after critical was given prior in the day, you can only bill the critical care.
 
Mod -25 is an E&M modifier not a CPT modifier

Examples:
99213-25 OV
93000 EKG

99396 routine preventive OV
99212-25 separate identified/eval problem

99232-25 subsequent hosptil visit
93510-26 left heart cath (did not list the usual addtional cath codes)

Most important is that for each E&M with mod -25 the documentation must support that a significant separate E&M service was provided in addition to the other coded/billed service the same day
 
Need to file claim please help

our doctor wants to bill a 99396 99213 and 17000

99396
99213, 25
17000, 51

Giving that I audit and find that the documentation supports the additional office visit, would this be the way to code this. I tell them all the time do not do this and they do not listen.

danielle
 
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