Wiki Modifier 25

[krssy70]

I have a patient that underwent surgery months ago, and now has a wound seroma. She continues to follow-up in the office every 2 weeks, (THE PLAN)with the physician for a wound-VAC closure. My question is can we bill an office visit every time the patient comes back with a mod 25. The physician has this plan for the patient, and the patient is only being seen for the wound-VAC closure. However, the physician is dictating an HPI for the cancer diag, along with a Past HX, and Phy Exam, but is only treating the patient for the wound closure. Because he is doing an HPI, and Phy Exam, is the procedure considered separately identifiable??????

 

[kbarron]

Are they in a 90 day global? If they are, it is part of the surgical package.

 

[krssy70]

The patients surgery was in January, so no global period pertains.

 

[krssy70]

Please help!!!! If anybody knows the answer to this question, I would greatly appreciate a response. This patient continues to come back to our office for this wound-VAC closure of this complicated wound... Please keep in mind, that this is a planned procedure, not within a global period, and the doctor dictates a HPI, PFSHx, and physical Exam on every visit due to the diagnosis of the patient, History of stage 1A, grade 1 endometrioid adenocarcinoma of the uterus.

Please help!!!!! Do I bill the office visit with a mod 25 and the procedure 11040, or just the procedure?????

 

[kbarron]

I would only code the procedure as that is the chief complaint.

 

[kjstearns]

In this case, you should only be billing the procedure. An E/M is only billable if it is for a separate, unrelated problem.

Hope this helps!
Kirsten, CPC

 

[Mjones7]

Hi Kirsten, in this scenerio, I too would only code the procedure as you are not meeting the definition for use of the -25 mod with and E/M.