Wiki Using Modifier 25 for Toradol Injection

[vrf19977@aol.com]

Hello! I'm a new coder (been working about 2.5 months), so please be patient in your replies, and dumb it down if you can, as I'm still learning all the lingo and verbiage of coding!

I work for neurology, and we frequently end up giving Toradol injections for pain. My question is whether this would warrant using the 25 modifier on the E&M codes. My understanding of the whole gist of "is this a significant and separately identifiable service" is to ask ourselves "did the provider plan or expect to perform this service before going into the exam room?" In the cases of these injections, it's almost always no. Which leads me to think that the 25 modifier is justified.

Thoughts?

 

[jkyles]

Hi there, you're on the right track but this question doesn't contain enough detail. Please search for "Modifier 25" in the forum and on the website. You will find tons of discussion and articles about when it is and is not appropriate to use modifier 25. If you don't find an answer then please provide an example of an encounter where you aren't sure whether it's appropriate.

 

[EditaPetrosyan]

Modifier -25 isn’t based on whether the injection was planned ahead of time. It’s used when the provider performs a significant, separate E/M service beyond what’s normally required to give the injection. If the provider evaluated the patient, assessed the pain & made a clinical decision to give Toradol then 25 may be appropriate. If the visit was mainly for the injection with minimal evaluation then 25 would not be appropriate.
Documentation is what ultimately supports the modifier.