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-25 mod on medicine codes?

  1. Default -25 mod on medicine codes?
    Medical Coding Books
    I have been told in the past to not use -25 mod on medicine codes, such as 93010 and 92950 but can't find any documention regarding this. We are getting denials when the mod is not used. Anyone have anything written as to use or not use?


  2. #2
    Greeley, Colorado
    CPT appendix A modifier -25 definition clearly states that this is an E/M modifier only.
    Lisa Bledsoe, CPC, CPMA

  3. Default
    Sorry, my question is whether to put the -25 on the E/M when coding a medicine code.

  4. #4
    A 25 modifier would be used on the E/M when billed with another service that has a global day period to show that the E/M is separately identifiable from that other service and should be reimbursed in addition to the other code. 93010 has "XXX" for global days and I see 92950 has "000" so technically, you shouldn't need the 25 modifier when you bill an E/M with 93010.

    With that said, some payers have their own rules so I'd still check on it and learn what the payers want.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  5. #5
    Greeley, Colorado
    I agree with Pam. Payers have their own guidelines. We usually have to use -25 on the E/M when any other service is performed (EKG, Neb tx, injections, etc). In fact, we have one payer that requires not only -25 on the E/M but -59 on EKG's...
    Lisa Bledsoe, CPC, CPMA

  6. Default
    I have a modifier ? on pediatric visits and meds/nebulizer therapy if someone can contact me on this site or my email

  7. #7
    We do it the same way here as Lisa mentioned. -25 with all EKG's/CT's, etc.

  8. Default
    Thanks, all.

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