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Modifier 25

  1. #1
    Default Modifier 25
    Exam Training Packages
    I have a patient that underwent surgery months ago, and now has a wound seroma. She continues to follow-up in the office every 2 weeks, (THE PLAN)with the physician for a wound-VAC closure. My question is can we bill an office visit every time the patient comes back with a mod 25. The physician has this plan for the patient, and the patient is only being seen for the wound-VAC closure. However, the physician is dictating an HPI for the cancer diag, along with a Past HX, and Phy Exam, but is only treating the patient for the wound closure. Because he is doing an HPI, and Phy Exam, is the procedure considered separately identifiable??????
    Kristen Richard, CPC

  2. #2
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    Are they in a 90 day global? If they are, it is part of the surgical package.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Default
    The patients surgery was in January, so no global period pertains.
    Kristen Richard, CPC

  4. #4
    Default
    Please help!!!! If anybody knows the answer to this question, I would greatly appreciate a response. This patient continues to come back to our office for this wound-VAC closure of this complicated wound... Please keep in mind, that this is a planned procedure, not within a global period, and the doctor dictates a HPI, PFSHx, and physical Exam on every visit due to the diagnosis of the patient, History of stage 1A, grade 1 endometrioid adenocarcinoma of the uterus.

    Please help!!!!! Do I bill the office visit with a mod 25 and the procedure 11040, or just the procedure?????
    Kristen Richard, CPC

  5. #5
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    I would only code the procedure as that is the chief complaint.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  6. #6
    Location
    Seattle First Hill
    Posts
    126
    Default
    In this case, you should only be billing the procedure. An E/M is only billable if it is for a separate, unrelated problem.

    Hope this helps!
    Kirsten, CPC

  7. #7
    Default
    Hi Kirsten, in this scenerio, I too would only code the procedure as you are not meeting the definition for use of the -25 mod with and E/M.
    Mjones7

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