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Thread: Office visit and 25 modifier

  1. #1

    Default Office visit and 25 modifier

    AAPC: Back to School
    we do several supartz injections, 5 over a 5 week span- my question is after the first office visit can we bill additional office visits for the next (planned) injections, with the 25 modifier?


  2. #2


    You would not bill out an office visit with a "planned" Supartz injection. You would only bill for the knee injection 20610 and the medication(Supartz) J7321. If the doc saw the pt on the same day for a completely, separately identifiable problem, then you could bill out an office visit with a 25 modifier.
    Ann Marie CPC
    New Britain, CT

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    Yes Ann Marie is correct, and the payers do watch for this.

  4. #4


    Thank you-- I have been trying to explain that to the doc--maybe with backup he will be able to understand.
    Last edited by richelle25; 06-04-2009 at 02:51 PM.

  5. #5
    Join Date
    Apr 2007
    North Carolina


    I completely agree with Anne Marie and Michelle-

    Maybe presenting the information below could help....

    Both the medically necessary E/M service and the procedure must be appropriately and sufficiently documented by the physician or qualified NPP in the patient’s medical record to support the need for Modifier -25 on the claim for these services, even though the documentation is not required to be submitted with the claim.



  6. #6

    Default fracture billing for a children hospital

    when a patient come in for the first fracture
    1. can you bill an e/m-25,fracture,supplies,x-ray?
    2. when they come back for replacement cast,splint,or strappling,how do you bill?

  7. #7


    For a nondisplaced fx, bill out either the fx charge or the OV, not both.

    For a displaced fx, you can bill out an E/M along with a fx charge so long as there is sufficient documentation to support it.

    As far as casting after the initial fx charge, we use modifier 58 on our castings. For casting supplies, it depends on the payer, and also whether it is plaster, fiberglass, gortex. Medicare and Anthem BCBS only take Q codes for casting supplies, while everyone else takes A codes. Our medicaid in CT only accepts 99070 for casting supplies, check with your local Medicaid for that.
    Ann Marie CPC
    New Britain, CT

  8. #8

    Default ortho

    can you give me some examples 25560 , 29075,&97760?

  9. #9


    Not quite sure of what you are asking for.
    29075 is a short arm cast, we put a 58 modifier for subsequent casts after the inital casts, the Q code for medicare and Anthem (fiberglass) is Q4010 for an adult. The A code would be A4590 for all other insurances.

    97760 is an orthotic fitting, for example, a CAM walker. We do not put a 58 modifier, but for Medicare you need to put a modifier of GO on it in order to get it paid. This applies to Medicare only, all other insurances, don't put a modifier on it.
    Ann Marie CPC
    New Britain, CT

  10. #10

    Red face what about 99211-25

    Medicare now requires that the doc be onsite but isn't this what the 99211 is for? ie the professional component regardless of how minimal? The -25 indicates to the claims adjudication software to look for a linked procedure which would have the -59 modifier. the rules may be different for incident to billing and they change daily per the CMS manuals online. But only a doc should be injecting a joint regardless. And furthermore the doc should do a minimal exam and document that the joint is not warm or inflamed before injecting steroids eg and VS would not be a bad idea either. A patient with low BP or irregular pulse from afib could faint from the needle stick just from the lidocaine and a small guage needle. That is what the 99211 is for. It is not a good idea to jump into an injection of any body part without vital signs and an inspection of the injection site and to document that to support an E and M code no matter now minimal such as a 99211. Any doc or nurse knows that.
    Last edited by careymvigor; 03-23-2015 at 04:21 PM.

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