Wiki modifier 25

[jelly239]

So im trying to figure out what mofifier 25 means.... I have read the definition in the cpt manual give times and it doesn't make any sense to me.....

I would really appreciate some clarity on this topic

 

[Wendyh50]

Modifier 25 is used to separate

procedures often bundled with office visits on claims
example

99213 25
69210 59

why these service can be bundled by Medicare if no modifier

Ekgs 93000 are another example...

look at the LCD for the procedures and you will notice unless clinically indicated usually are included int he office visit payment.

 

[mitchellde]

Let me try this:
Every procedure in the book has as a natural component the evaluation necessary to follow the procedure through to completion. If the E&M is significant; meaning beyond what is needed for the procedure,but still applicable to the patient's presenting issue(s),; and separately identifiable; meaning are the key elements of the E&M able to be separated from that which is needed for the procedure and still have a viable level; then you meet the criteria for the 25 modifier. You do not need a separate dx code only the criteria for the 25.

 

[Lynda Wetter]

Let me try this:
Every procedure in the book has as a natural component the evaluation necessary to follow the procedure through to completion. If the E&M is significant; meaning beyond what is needed for the procedure,but still applicable to the patient's presenting issue(s),; and separately identifiable; meaning are the key elements of the E&M able to be separated from that which is needed for the procedure and still have a viable level; then you meet the criteria for the 25 modifier. You do not need a separate dx code only the criteria for the 25.

I wish there was a like button for this