Wiki use of modifier 25

[LorriK45]

somebody help me!! i've been a coder for 16 years and was told today that i don't know how to use modifier 25 correctly!!, i have never appended modifier 25 to an office visit that resulted with pt having x-rays and an ekg, i only use it for injections and "minor" surgical procedures i.e. destruction of lesion. how could i have misunderstood this modifier so horribly? or am i the one that is correct?

 

[Murugan Kannuthal]

“When there's no modifier 25, the procedure with highest RVUs gets paid and, in this case, the X-ray would just be considered part of the visit and not paid,” Owens-Frierson says.

Medicare and other payers give close scrutiny to documentation when they see modifier 25. Irvine says the safest route is to make sure each service — the procedure and the E&M visit — has sufficient documentation to stand alone and clearly indicate that two distinct services were provided.

Hope it will help you.

Thanks,
Murugan.

 

[aaron.lucas]

check the NCCI edits, if the e/m you're billing bumps up against the x-ray or ekg, which I cant imagine it would but if it does, then you would need modifier -25 along with supporting documentation. also obviously if the guidelines state to use mod -25, then you should. see the CMT guidelines as an example of that. aside from that the only time you need a modifier -25 is if you're billing on the same day as a "zero global day" procedure, which like you said is mostly injections/minor surgery. You're probably right, who said you dont know how to use mod -25?