Wiki Using modifier -25

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BRUKAT74

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The patient schedules an appointment for a lump on the chest. When he presents to the office, provider does a full H&P, report and I&D Procedure. All documentation supports 99214 with 10060 for the I&D. Do I add the -25 modifier to the E&M in light of the reason for visit being scheduled for the lump on his chest?
 
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If the intention of the visit was to have the lump assessed, then based on the exam, the provider decided to perform an I&D, the use of modifier 25 would be appropriate. The visit where the decision for the procedure is made is billable separately from the global. If the patient was scheduled intentionally for a procedure, you wouldn't be able to bill the 99214. It's hard to say without seeing documentation.

This article is helpful: https://www.aapc.com/blog/46373-your-quick-guide-to-the-global-surgical-package/
 
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