Wiki Use of Modifier -25 Question

[bborja72874@aol.com]

Patient had accident in home and reported to the ER with chest pain, rib pain, and headache. Final diagnosis was contusion of the rib and sprained ribs. The EM Level was coded as 99281 without a modifier -25. We are receiving an edit for the chest x-ray and CT of the chest. Should this claim have the -25 modifier attached to the EM 99281 since the x-ray and CT are incidental to the reason for visit?

 

[SusanBrown]

Modifier 25

modifier 25 would be used on the ED visit charge when billed with xray, ekg/ecg, ct scan or procedure.

 

[smonahan]

Since you have the CT with the E/M level you will need to use the 25 modifier. X-rays submitted with E/M levels do not require the modifier 25 if they are the only other service billed.

 

[pamsbill]

I don't think anyone should just smack a 25 modifier on a code just to get it paid. You have to look at the documentation and a decision needs to be made if it applies under the particular circumstances. Often it is a decision the physician needs to make. I would not add such a modifier without the blessing of the physician because it means you are stating those E&M services were over and above what is typical to perform with the procedure(s). In other words, the procedures have a portion of E&M automatically built into them. In order to bill an additional E&M code, the amount and complexity of E&M services must go beyond what is usually associated with the procedure(s).

It scares the ***** out of me to see suggestions of "just add a modifier."

 

[emcee101]

agree with Pamsbill, well said.