Wiki Modifier 25 on E/M Code

[dballard2004]

A patient comes into the clinic for a preventative visit and immunizations are administered. According to the guidelines, in this case you would append modifier 25 to the preventative E/M code. In this same encounter, the provider also addresses an additional complaint and performs and additional E/M service. According to the guidelines, in this case, you report the additional E/M with modifier 25.

Here is my question....since immunizations were administered as part of the preventative visit and an addtional problem was addressed requiring an additional E/M code, do you put modifier 25 on both the preventative E/M code for the immunizations and the additional, problem-oriented E/M for the additional complaint?

Thanks.

 

[hewitt]

If you do not mind, better to give us the CPTs so we can visualize what you are doing.

 

[dballard2004]

For example:

99396
99212
90471
90658
90472
90732

Would you add the 25 modifier to both E/M codes (for example):

99396 25
99212 25
90471
90658
90472
90732

or just add the 25 modifier to the problem-oriented E/M code:

9939
99212 25

 

[hewitt]

Remember, use of 99212 assumes documentation of a "Significant, separately identifiable evaluation and management service...." ...just add the 25 modifier to the problem-oriented E/M code: 99396, 99212 25. If this fits, you probably should use a diagnosis appropriate to the problem.

 

[dballard2004]

Thanks.