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Use of -25 Modifier with in-office procedure

  1. #1
    Default Use of -25 Modifier with in-office procedure
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    Can anyone cite a source that will clarify if a -25 modifier appended to a 99214 E&M visit when 46916 times 8 was done in the office at the time of the visit for "golfer's elbow" (different DX for E&M service) procedure code?

    Wouldn't the level billed for the E&M exclude time spent performing the 46916's?
    In other words, the E&M would be based solely on the complaint of "golfer's elbow"?

  2. #2
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    First, I don't think 46916 should be billed in units.

    46916
    Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery


    Based on my understanding of the code it doesn't matter if you do 1 or 50 you only get to bill it once per date of service.

    You would need the 25 on the E/M or it will be bundled into the procedure regardless of the dx. I don't think insurance systems look that far. The first edit they hit they kick them out.

    Laura, CPC, CEMC

  3. #3
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    Columbia, MO
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    Laura is correct on the units for that code, I am trying to get over the use of golfers elbow for a destruction of lesions of the anus!!!!! Can you provide any clarification?

    Debra A. Mitchell, MSPH, CPC-H

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