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Thread: modifier?

  1. #1

    Default modifier?

    AAPC: Back to School
    okay so very new to ortho coding ... question i have a patient in for a po visit but out of the global so... e&m code will be used obviously... but at the same visit she had cortisone injection in the shoulder...so .... how would that work with modifiers??

  2. #2
    Join Date
    Apr 2007
    Columbus GA


    Modifier -25 - (as defined by the American Medical Association Current Procedural Terminology: CPT 2005, Professional Edition) Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service. The modifier was created for situations when the physician needs to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. The E/M service may be prompted by the symptom or condition for which the other procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding modifier '25' to the appropriate level of E/M service. Modifier 25 is used to identify a significant, separately identifiable evaluation and management service performed on the same day as another procedure or service by the same provider.

  3. #3

    Default ahh


  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Reason for visit?

    If the reason for the visit was to get the injection ... then you bill ONLY the injection and NO E/M.

    If the reason for the visit was follow-up for xxx (example: shoulder pain), and a decision was made to give the injection as a result of the evaluation of patient .... THEN code the E/M with -25 modifier and the injection.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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