Wiki Modifier 25 on E/M and ultrasounds

[OBcoder2017]

Is it necessary to append modifier 25 on a separate E/M if a patient comes in with a problem and doctor decides to do an ultrasound? Our OBGYN does an ultrasound each visit to reassure the mother. On some occasions, however, patient comes in with a concern like spotting, contractions, bleeding, reduced fetal movement and he does an ultrasound on that visit to assess the problem in addition to a separate E/M. Would modifier 25 be required? Medicaid has given conflicting answers to this question. The reason this is coming up is when we have to backcharge because patient has broken global. We bill for the ultrasounds per visit.

Lisa Gaines, CPC-A

 

[misib]

Yes if an E&M was done bill the appropriate E&M with modifier 25 and then the ultrasound code. If only an ultrasound was done bill it alone.
Presently I work in an all GYN office and we do not bill Medicare or Medicaid so I am not sure of their guidelines...there are probably limitations to the number of u/s a pt receives during prenatal care...make sure the dx code(s) & documentation support the u/s procedure.
Hope this helps.
tn/misib

 

[OBcoder2017]

Thank you very much for your time in replying!

 

[cjorr65]

Medicaid does have limitations for ultrasound in pregnancy. Two u/s per pregnancy unless there is a medical reason in that case depending on the medicaid you may need a precertification in order to receive payment. I also work OBGYN