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Thread: Consult called for I&D

  1. #1

    Default Consult called for I&D

    AAPC: Back to School
    I am trying to figure out if I should apply modifier 25 to this consult or if it should be included in the visit. I know under certain circumstances, mod 25 does not need to be applied.

    The ER physician called the orthopedic to do an I&D. The reason for the consult stated I&D and cellulitis ankle. The physcian did an evaulation and did a handwritten note stating, "I&D in the room, CTS sent, irrigated."

    Is this sufficient documentation to bill or should this be included since it was already understood an I&D needed to be performed?


  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default No consult

    If the surgeon was called to perform the procedure, there is no consult. It's a transfer of care.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Urbana, IL


    It depends on the ED doc's intent, was he asking for advice or opinion of possible I&D and evaluation of the ankle cellulitis? It also depends on the surgeon's note, did he need to perform the e/m to make the decision for the i&d? If the answer to the above questions is both "yes" and documentation supports then I would say consult with 25 mod and i&d procedure code should both be reported. If you have access it may help you to review the Principles of CPT and Coding with Modifiers. These great resources will support my statements; however it is up to the providers' documentation to support the medical necessity.
    Dawn Peterson
    Coding Consultant/Billing and Coding Instructor
    Illinois, USA

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