During a normal follow-up at the PCP the doctor orders that the patient have and EKG and CXR at the end of the visit. There is no medical necessity for either procedure and no supporting Dx's. Would I still use modifier 25? I'm a little confused because I don't think they are "significant procedures" since there is no diagnoses to support them..
I think you
may be confused...I have a couple of questions

:
First: Was this a problem-oriented visit (with a Chief complaint, symptoms, chronic illness, etc.), or was it a routine well-check?
Your answer on that, will determine a lot about how you can bill this - if it's routine, you'd bill a preventive E/M 99381-99397, or the appropriate G-code (HCPCS) for a Medicare patient. If using a G-code, there's a chance that the EKG and CXR are included in the office visit, and can't be reported separately, but it's hard to say for sure, with the information provided here.
If there's a complaint (eg, HTN, COPD, etc.), then you'd use a problem-oriented E/M (99201-99215); the diagnosis used for the E/M may or may not be the same as the diagnosis used for 93000 and 71020. 93000 can be performed as part of a routine exam, so it can be billed with a routine diagnosis (eg, V70.0); 71020 will likely deny, if there's no problematic-reason for the procedure, documented - that's not usually a covered preventive benefit.
93000 & 71020 don't bundle into a problem E/M's, or into preventive E/M's (CPT only). As I mentioned earlier, they might bundle into a G-code, such as G0438 - but that's only going to be an issue if it's a routine visit for a Medicare patient (if that's the case, you should check with your MAC for billing instructions).
More than likely, you've got a chief complaint listed there somewhere, and you're overlooking it (they can be tricky to find, sometimes). Without seeing the note, though, it's impossible to say whether or not the EKG or CXR was medically necessary, or what the correct diagnosis would be for those.
Either way, if those are the only procedures billed, your E/M shouldn't require a 25 modifier. You'd only need one, if you bill a procedure/service, that an E/M bundles into (such as an injection administration - 96372, or a breathing treatment 94640).
The 25 modifier ONLY goes on E/M codes - never on 93000 or 71020.
If you billed other procedures which would necessitate a 25 modifier on your E/M (such as 96372 or 94640), then it's likely that your EKG will require a 59 modifier, as well. Once again, you ONLY need to add the modifier,
if the services bundle, in the first place.
Check NCCI edit tables, if you're unsure, or if you still need help, provide the details from the note (Just copy all of the note, minus any identifying information, like the patient/provider name or DOB). I'll gladly assist, but unfortunately, this is the most help I can be, with limited info. Hope that helps!
