Modifier 25 when performing xrays

[medicode3]

Hello. I need some clarification please. I attended a class yesterday in which it was stated that when billing xrays you are not to use modifier 25 when billed with an E/M. They also stated that no modifier 25 is needed on the E/M when billing vaccines. This I understand because you use different dx's. Can anyone chime in on this? Thanks

 

[mitchellde]

Hello. I need some clarification please. I attended a class yesterday in which it was stated that when billing xrays you are not to use modifier 25 when billed with an E/M. They also stated that no modifier 25 is needed on the E/M when billing vaccines. This I understand because you use different dx's. Can anyone chime in on this? Thanks

I would clarify with the instructor. when you are billing outpatient facility and you have the facility E&M with an xray you do not use the 25 as the xray is a status x procedure. Not all radiology however as ultrasounds do need the 25 on the E&M as they are a status S. This is for facility.
For physicians there is no concrete definition of significant procedure and sometimes the payers follow the the same rules as the facility and sometimes not so we usually do append the 25 to the OV with xrays.
As far as the vaccine administration is concerned, yes we do use the 25 on the E&M whether facility or physician as the admin codes are a status T for the facility. This is assuming of course that we are billing for a significant physician encounter in addition to the administration of the vaccine.
Again I would ask the instructor to clarify this statement so you can see where she is coming from.

 

[dballard2004]

I'm speaking from the physician side here, but we never append modifier 25 to the E/M with x-rays. If you reference the NCCI edits, I don't see where the E/M codes are considered bundled with the x-ray code (unlike some other procedures), so I don't think modifier 25 would be necessary.

Maybe I'm wrong, but this is my perspective.

 

[jthweatt]

Our Medicare carrier, Cahaba GBA, requires that we amend a 25 modifier to the E&M if it is billed with any procedure that includes a professional component - xrays performed and read in the office for example. None of our other carriers has this rule, so it is more of a billing thing than a coding thing.

 

[Lujanwj]

I don't do billing so I'm not aware of certain payors requests for billing. With that being said, most if not all Radiology codes have an XXX global status (CCI) which indicates that the global concept does not apply, again per CCI, so no modifier is needed.