Wiki modifier 25 - our breastcare center

[mass31]

Patients PCP sent her in to our breastcare center at the hospital for discolored nipple and tenderness after taking antibiotics a few weeks earlier for a breast infection...there was an clinic visit G0463 a diagnostic mammogram G0206 and a breast ultrasound 77641 should modifier 25 be added to G0463? She is 74 and has medicare

 

[cynthiabrown]

G codes never use 25 mod

 

[mitchellde]

Are you coding for the outpatient facility or for the physician?

 

[mass31]

For the outpatient facility

 

[LisaAlonso23]

Modifiers 24 & 25 are only used with E/M codes.

 

[mitchellde]

For the outpatient facility

Was the mammogram pre scheduled?

 

[mass31]

Yes the imaging was pre scheduled

 

[mitchellde]

If the imaging was prior scheduled, then the same rules apply for the 25 modifier usage. Meaning you need to have services above and beyond the reason for the encounter. For a prior scheduled mammogram you will have no rationale to charge for the clinic visit as well as the mammogram. The facility resources consumed were all for the test. Bill only the mammogram and ultrasound.