Wiki Office visit and counseling code

[Shortcakecoder101]

I'm billing a new pt e/m code and counseling code for ob/gyn. Can I use a 25 modifer code on both?

 

[danskangel313]

A 25 modifier wouldn't be appropriate as the patient is not having a procedure done. What codes are you using? If the patient received counseling during an office visit, that should be counted when leveling the office visit charge rather than billing separately. If you can provider additional information, that would be helpful.

 

[Shortcakecoder101]

I'm using a 25 modifer on 99215 with dx N96.4, then the counseling code of 99401 with dx Z71.9. Is it correct that the o/v gets the modifer?

Thanks

 

[danskangel313]

I'm using a 25 modifer on 99215 with dx N96.4, then the counseling code of 99401 with dx Z71.9. Is it correct that the o/v gets the modifer?

Thanks

I couldn't find N96.4 as a valid DX code... typo maybe? As far as the Z71.9, because it's an unspecified code, it's highly unlikely the 99401 would get paid using it. Nonetheless, a modifier shouldn't be needed as long as there's documentation to show that the office visit 99215 is completely separate from the counseling service.

Also, if this is a new patient, you'd need to look at 99205 instead of 99215.