Wiki Modifier 25 twice????

[HavaTwo]

A patient and his mother presented for a well child exam with immunizations. His mother also stated that the patient had fallen from his skateboard the night before, and his right knee was bruised and swollen. Patient was noticeably limping when he entered the exam room. Doctor performed the well child exam, but had a separate physical for the right knee which documented the bruising and swelling. Doctor ordered an x-ray of the knee, which was negative, and prescribed ibuprofen. Patient was given a knee brace and crutches, and was advised RICE. Patient was also given HPV, Gardasil and DTaP vaccines. My codes:

99394
99213
90471
90472(2)
90734
90749
90715

My question is in regards to the modifiers. If only the well child and immunizations were performed, a -25 modifier would be attached to the 99394. If the immunizations had not been performed, modifier -25 would be attached to the 99213. Can you use modifier -25 twice for one encounter??? Is there another modifier I should be using???

 

[Saedron]

No, you can't use modifier 25 twice. What you use depends on your payer. Some want 51, some want 59. For example:

99394
99213 -25
90471 -51
90472 -51
90734
90749
90715

Some payers want 59 instead. Some don't want any modifiers (Medicaid) on the vaccine admin codes at all. Best to call the payer and see if they will tell you which one they want or dig into the payer's website and look at the medical policies.

 

[dorinda05]

Only append modifier 25 to the 99213 as it was a separately identifiable service performed. However, be sure the dx attached to 99213 is specified to the knee injury. No need to append it to the WCC.