Wiki Modifier 25 with 36415

[LauraF1225]

Hello -

This is a facility level question...When a patient is seen by the provider and has blood work done (CBC, basic metabolic panel, etc) should a modifier 25 be added to the facility level? When the 25 if not added it is hitting an edit in our system saying it should be added. I do not agree with the edit, and I wanted to hear from a few other people as to what they thought was the correct way to code this.

Thank you for any and all help!

Laura

 

[thomas7331]

I do not get an edit on my facility encoder for 36415 billed with a physician visit without a modifier, but your edits may be set up based on your facility's particular payer rules. If that's the case, there should be no problem with adding the modifier 25. In this situation it will probably not make a difference in payment - for Medicare, at least, the 36415 is a packaged code under OPPS is not paid separately even when the modifier is added.

 

[amandapreno]

No, 36415 does not require a 25 be appended to the E/M.