Modifier 25 with X-rays? AAPC practice exam says it is required?

JMichelle

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Maybe I am missing something... I am trying to clarify the issue.

I was taking the AAPC module that I purchased: Specialty Practice Exam COSC™
And on Case 20 it goes over a basic office visit for knee pain. All that is done is an e/m and an x-ray, 73562.

Question three asks if a modifier should be appended. I chose no, which it says is incorrect, the rational being:

The provider performs an E/M and radiology service. According to NCCI policy, when a provider performs a significant and separately identifiable E/M service with a procedure with XXX global days, append modifier 25 to the E/M service.


I am so confused. I have never used modifier 25 on an OV for just a knee xray since the xray has no gobal?
I would have gotten this wrong on the exam... Can anyone explain why this is correct?
I understand using it in cases with minor procedues like 20610 but an xray??
 

CPC&COSCinPA

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This happened to me as well and when I questioned it I received the following response. Thankfully I did not have the question on my actual exam, like you I have never appended mod 25 to an E/M & x-ray only. Good Luck!

For those procedures that have an 'XXX', per NCCI, an E/M code may be applicable with modifier 25. That E/M service may be related to the same diagnosis that prompted the procedure. We understand not all payers, depending where you live, request you to append modifier 25 on the E/M with an XXX procedure. Because the COSC exam is a national exam, we follow NCCI to append modifier 25 to an E/M service when a procedures such as X-rays that is designated as an XXX procedure for the COSC.

Nicole
AAPC
http://www.aapc.com
Advancing the Business of Healthcare
 
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