Modifier 25 question

[MAJACOLI]

If a patient comes in for a post-op check up and has an injection given in the post-op site, where would you put the mod.25 since 99024 is a zero charge and will not print out on a claim? All input is apprieciated!

 

[mbort]

you wouldnt use the 25 modifier. Use the appropriate injection code with either the 58/78/79 modifiers as appropriate.

 

[MAJACOLI]

The patient was seen in the office not returning to the operating room nor was it a staged procedure.

 

[FTessaBartels]

-79 unrelated procedure OR service

Modifier -79 is for "Unrelated Procedure or Service by the Same Physician During the Postoperative Period"
If you read the description in Appendix A of CPT there is no mention made of returning to the OR.

So, if the injection is unrelated, mod -79 would be appropriate.

F Tessa Bartels, CPC

 

[LindaDuckworth]

don't forget that related services to the original procedure, or determined to be a complication of the original procedure, (within the post-op period) are bundled into the first surgical procedure. You can get more global surgical information on the Medicare Physician's web site under internet manuals, Claims Processing 100-4, chapter 12, section 40 I believe. Or check the NCCI policy manual as well.

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

NCCI: http://www.cms.hhs.gov/NationalCorrectCodInitEd/01_overview.asp#TopOfPage