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Wiki Use of MOD 25 on a CPE

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ksarvis

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can you add a 25 to a 99381-99397? (physical exam). or do you have to do a 99396, an OV code and then add the 25 to the OV? (99202-99215)
thank you
 
In my experience (pediatrics), you should not use a modifier on the physical exam. You can code a physical exam and an Office visit, the modifier would then go on the OV. But keep in mind you need supporting documentation showing the additional work that supports a 99212-99215. This happens often in Pediatrics, as kids come in the office for their annual exam and are also sick. Some payers/plans only pay the OV at 50%.

Hope that Helps!
 
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