Wiki Using -25 modifier with Preventative

[smartin42]

I have several GYN OV's where they are placing IUD's on the same dos, I have always been told you cannot use a -25 on a preventative ov ex: 99395 and I am being told by a co-worker to use the -25 when this occurs. Please help I cannot find anything to back this up. Thanks!

 

[CodingKing]

I don't see why you cant. Annual exam would be would be distinct and separately reimbursable from the IUD insertion. 25 can be used on E&M codes and 99395 is an E&M code.

 

[1formissy]

I don't see why you cant. Annual exam would be would be distinct and separately reimbursable from the IUD insertion. 25 can be used on E&M codes and 99395 is an E&M code.

I agree with the above. No reason you cannot report the 25 code to distinguish the preventative is separate from the IUD service. If a payer is denying it, I would recommend you appeal.

 

[Anastasia]

Lately several of our payers are denying any procedure performed during a preventive exam so you may want to check with your carriers.

 

[1formissy]

Lately several of our payers are denying any procedure performed during a preventive exam so you may want to check with your carriers.

I audit for a payer and a majority of the physicians are family providers so I see a lot of preventative visits billed with Medicare Wellness Exams and occasionally E/M visits on the same encounter.
As long as the documentation supports a significantly separate and identifiable service from the preventative, than I allow payment.