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Preventive and Sick Visit on same day


Best answers
when billing a preventive and sick e/m on the same visit i know the modifier 25 goes on the sick e/m but if there are vaccines as well does the modifier 25 go on both preventive and sick e/m code?


Milwaukee, WI
Best answers
CCI Edit

You would need a modifier on both the E&M and the Prev Med visit. There are CCI edits that bundle both an E&M and/or a Prev Med visit into an immunization administration. If you only append the 25 modifier on one of those codes, the admin will bundle into the other when the claim is processed, if the payer is following the CCI edits.

I hope this helps!
Shelly L. Kubacki, MPA, CPC