Modifier -25 - know the guideline

Maryst

Networker
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64
Location
Nashville, TN
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Could someone please let me know the guideline on -25 as far as immunizations and injections? Is that considered a seperate service? Example: If a patient comes in for an office visit and decide they want a Flu shot, DTAP, or HPV? Would you add a -25 to this?
 

HCC12345

Networker
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San Antonio, TX
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Yes, if you are billing 90471 or 90772 you need a 25 modifier on the office visit. The drug does not bundle its the administration that bundles w/ your E&M code.
 

RebeccaWoodward*

True Blue
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North Carolina
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Drug Administration Services and E/M Visits Billed on Same Day of Service
Carriers must advise physicians that CPT code 99211 cannot be paid if it is billed with a drug administration service such as a chemotherapy or nonchemotherapy drug infusion code (effective January 1, 2004). This drug administration policy was expanded in the Physician Fee Schedule Final Rule, November 15, 2004, to also include a therapeutic or diagnostic injection code (effective January 1, 2005). Therefore, when a medically necessary, significant and separately identifiable E/M service (which meets a higher complexity level than CPT code 99211) is performed, in addition to one of these drug administration services, the appropriate E/M CPT code should be reported with modifier -25. Documentation should support the level of E/M service billed. For an E/M service provided on the same day, a different diagnosis is not required.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
 
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