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Thread: Modifier 25 usage clarification

  1. #1

    Default Modifier 25 usage clarification

    AAPC: Back to School
    I am looking for clarification (and documentation if possible) on whether modifier 25 should be used when the physician gives an injection or immunization or does in-office labs in addition to an office visit or preventive visit.

  2. #2
    Join Date
    Apr 2007


    Hello dovejsd, I would direct you to some of the best guidance that I can find through the American Academy of Family Practice website - www.aafp.org and put in a search for "modifier 25".
    This is a difficult but easy modifier to use. You have to be able to justify each service billed for. In the case of a patient coming in for ear pain/cerumen impaction: Doc does normal workup for ear pain and through the course of examination discovers a cerumen impaction which is curetted and irrigated clear. This service now qualifies for only code 69210 - BUT - an otitis media is now diagnosed. A workup and treatment plan is now completed for this ailment (in this case, prob only enough for a level 2 visit; established). While these conditions sort of "overlap" one another, they are different and require different treatments to resolve. A modifier 25 would apply here.

    Hope this helps
    Jason Steeprow, CPC

  3. #3
    Join Date
    Apr 2007
    San Diego



    I noticed you indicate "immunization" and just want to make sure you're billing for the Imm Admin codes (90471, 90472 for each additional...).

    Also, don't forget to bill for Inj Admin codes (90772, ...)

    Hope this helps!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  4. #4

    Default Try this link:


    "Carving Out" Preventive Medicine Services

  5. #5


    Quote Originally Posted by codercab View Post

    "Carving Out" Preventive Medicine Services
    This was a great link. So, Did I understand the article correctly. Can you attach modifier 25 to a preventive medicine service? Thanks dee

  6. #6

    Default modifier 25

    If pt A comes in for a BP check and diabetes and has chest pain while there and the Dr does an EKG. Do you use modifier 25 in this situation? How do I code this?

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