Wiki To use or not to use the 25 modifier - that is the question?

[jdibble]

I have searched for a definitive answer to this question and everything I see has been flip flopping between using the modifier and not using the modifier...

The scenarios are:

1. I have an orthopedist who takes x-rays in his office - he owns the machine and does the interpretation and is billing the global. Would you need to use a 25 modifier on the E/M?

2. I have a cardiologists who does his own EKG's and does the interp. Same thing - bill the E/M with or without the 25 modifier?

Can someone please give me an answer to this and a source if possible. I will be doing an audit for these practices on their use of the 25 modifier and I need to know so that I can educate them on the proper use!!

Thank you for all responses!

 

[skraft1969]

X rays and EKG's

You don't need a modifier 25 on the E/M for and XRAY, but you do need it on the E/M if and EKG is done on the same DOS.

 

[jenneverett]

Our practice does not "25" the E/M with the EKG on the same day and we are getting paid by all payers and Medicare without it.

Jennifer

 

[jdibble]

Thanks Jennifer and Skraft for your input. So now can I get a tie breaker on the question of using the 25 modifier with the EKG?

 

[Cynthia Hughes]

Because the Social Security Act requires separate payment of an electrocardiogram provided on the same date as a visit or consultation, the services typically are not bundled and no modifier is required. Private payers may differ in their policies.

"3) Treatment of interpretation of electrocardiograms.— The Secretary—
(A) shall make separate payment under this section for the interpretation of electrocardiograms performed or ordered to be performed as part of or in conjunction with a visit to or a consultation with a physician, and
(B) shall adjust the relative values established for visits and consultations under subsection (c) so as not to include relative value units for interpretations of electrocardiograms in the relative value for visits and consultations."

 

[jdibble]

Thank you Cynthia! That was very informative and helped me greatly!