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Wiki Modifier -25 - your practice codes

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hthompson

hthompson

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Can you tell me if your practice codes a -25 with E/M for everyone who had something else done during the visit, like 81003 or 87880 or 81025? Do in house labs count as a procedure or service as defined by AMA?

I am trying to get this right because mod -25 was never explained to me properly until a brick hit me in the head yesterday (figuratively speaking).

Now I understand that with 20610, 11200, etc (actual procedures) that I'll add the -25 to the E/M that came with it, but what about labs and such?
 
Hi Heidi - based on conventional coding you would not need a modifier -25 on your E/M with a lab...HOWEVER - each insurance has their own policy on this. They don't follow what CPT states, so you'll need to check with each of your carriers. Adding mod -25 to all E/M's isn't going to hurt, it just goes against what we've been taught. You DO need it when an actual procedure is performed, such as 20610, etc. You cannot report an E/M if the patient was scheduled for the joint inj. Same for lesion removals, biopsies, etc. Hope that helps. Watch out for those bricks! :eek:
 
I think I just won't use it with labs. There was an OIG investigation in 2005, if I remember, and it said there was a lot of improper usage when practices were putting it on every E/M even when there wasn't a procedure. I don't want to be the cause of any red flags thrown around here :D

I'm working on my MDs for proper documentation for their procedures and working on the MAs to stop trying to force the MD to put an E/M for every visit because they think the page looks funny w/o it and they were taught that every visit needs an E/M.

I had an MD carry over a superbill by hand with her MA by her side. She wanted me to tell her MA it was okay for her not to bill an E/M for that visit that she did an IUD insertion. I asked her if she ever had an office visit with her pt just to realize the pt needed an IUD? She laughed and said no. So I told her, then you only scheduled the pt for an IUD and that's all you did? She said yes. So I assured the MA that the MD was right in her thinking that it was a procedure only visit. :D Case closed. My job is done here :) (for a second or two)
 
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