Modifier 25 vs 59

[reddaway@sbcglobal.net]

Is is correct coding to use modifier 25 or 59 for the E/M service in the following scenario?

Patient was seen for E/M service by physician (99213 or 99214) and had an injection by a nurse (96372) same day.

 

[jorellana42]

Only the 25 modifier would go on the E/M, but if the reason for the visit was the injection, there would be no modifier on the E/M. Only add the modifier if there was a significant and separate evaluation and management of a condition that was unrelated to the need for the injection.

If the reason for the visit was the injection, the E/M will be denied as inclusive to the administration code (96372).

 

[reddaway@sbcglobal.net]

A follow up question. In this above scenario modifier 25 is correct and 59 is incorrect?

 

[twizzle]

You cannot use a modifier 59 on an E/M service

 

[wisibyusha]

Modifier 59 is not an E/M modifier.

 

[twizzle]

That is exactly what I said. Hopefully OP realizes that.