Wiki Modifier 25 vs 57

[aekenyon87]

My office does billing for only the ER physician and codes 99284, 26725 & 12041 were billed together. CPT 99284 was billed with 57 modifier and the insurance company states 99284 is within global period for CPT 12041 billed on same claim. Patient was sent to hand surgeon for further evaluation, but there is nothing in the medical record stating the patient actually had hand surgery. Would a 25 modifier be more appropriate for this situation? Thanks!

 

[cgaston]

Your E&M should have both -25 and -57 modifiers.

 

[aekenyon87]

Thank you!