Wiki Where can I find CMS rules for E/M & UA done in office

[Kerly F]

Do I need a 25 modifier on the E/M when an urine analysis is done the same day?
I need documentation (pref. CMS guidelines) stating if 25 is required on the 99214 (example) when billed with urine analysis in an office setting?

 

[btadlock1]

Do I need a 25 modifier on the E/M when an urine analysis is done the same day?
I need documentation (pref. CMS guidelines) stating if 25 is required on the 99214 (example) when billed with urine analysis in an office setting?

No, you don't have to bill the E/M with a 25 modifier with a lab code - any lab code. Are you billing 81001 with a QW modifier, though?

What's denying, and what reason are you being given?

 

[LaVoncye]

CMS urine

Hello
We bill for these services every day 1st. you do not need a 25 on the EM visit. With Medicare you have to use the G code, im not sure about the 80101 and you have to put the QW modifier on the G code. The G code is determined by the type of urine you are doing . You have to utilize your lab codes for medicare.