Wiki modifier 25?

[Helen3]

(for the Physician)
Pt seen originally 6/3/10 99214-25, 10160

Returns 6/7/10 99204, 10160-58,76 (Physician had to repeat the aspiration, not due to any complications)

Returns 6/14/10 99204, 19020-58 (physician performed a more extensive procedure on the same site)

Do I attach mod 25 to the post op 99024 (even tho' mod 25 is for E/M)? Also, can my doctor bill for these procedures done on the same site without mentioning any compllications?

Any assistance would be greatly appreciated.

 

[LindaEV]

You dont need a 25 on the 99024, since it is a non-billable (zero-charge) code.

I dont really see the need for the -76 either. Usually this is used for a "same day" situation.

for your additional procedures you're gonna want to use 58 (planned or related) or 78(unplanned - usually a complication)

He can bill for them if they are done...doesn't necessarily require a "complication", but he should document in his notes why each additional procedure was done.

 

[sbicknell]

99024 is a CPT code and not an E&M code. Mod -25 is not used on 99024 or any other CPT code. 99024 basically says "I have no billable E&M service"

The documentation should support the medical necessity for each of these procedures and the specifics of what was performed. If the 19020 was done due to complications then the documentation should support that and there are some 998.xx range of DX codes for complications that could be coded

I disagree regarding the use of -76. I have not seen any written guidelines stating "same day". I do agree that the documentation and reason for these f/up procedures determines the modifier -58 or -76 or -78 as the most appropriate

 

[Helen3]

Many thanks the help from both of you