Modifier -25 & preventive E/M

mkmgt001

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A patient had a preventive visit (CPT 99395) & a signficant, separately identifiable problem-oriented visit (CPT 99213-25), as well as destruction of benign lesions (CPT 17110). Coding programs (iCES) will deny the preventive E/M code as unbundled from the surgical procedure, but in my opinion, these services should be allowed separately. Would it be appropriate to report modifier -25 on BOTH the problem-oriented E/M AND preventive E/M in this kind of scenerio? Thanks!
 

shruthi

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A patient had a preventive visit (CPT 99395) & a signficant, separately identifiable problem-oriented visit (CPT 99213-25), as well as destruction of benign lesions (CPT 17110). Coding programs (iCES) will deny the preventive E/M code as unbundled from the surgical procedure, but in my opinion, these services should be allowed separately. Would it be appropriate to report modifier -25 on BOTH the problem-oriented E/M AND preventive E/M in this kind of scenerio? Thanks!


As per your scenario, modifier 25 should be added to office visit code to indicate that a significant, separately identifiable E&M service was provided on same day.
Also 25 modifier should be added to preventive visit to show that surgical procedure was done on same day.
We bill 25 mod to both E&M and preventive when performed with other distinct services.

Hope this helps.
 

mkmgt001

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Great...thank you so much for your input!! I thought it was probably appropriate to bill a modifier -25 on the preventive E/M in this kind of scenerio, but I couldn't find any resources to back me on this.
 
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