Wiki Use of MOD 25 on a CPE

[ksarvis]

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

 

[KimKrebs]

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!