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25 modifier use with outpatient clinic visits

  1. #1
    Default 25 modifier use with outpatient clinic visits
    Clearnace Sale
    A patient is seen by his hematology/oncology physician to discuss the status of his disease and chemo effects in the cancer clinic prior to the administration of his chemotherapy in the chemo clinic on the same day. Does this visit qualify for a 25 modifier since it is a 'service above & beyond the otherservice provided' (the chemo)? These services are being provided in hospital outpatient clinics, not in a physician's office.


  2. #2
    Offhand I would say yes, it qualifies, but it's all dependant on the documentation.
    Walker Bachman, CPC, CPPM

  3. #3
    Columbia, MO
    You are not to charge for an E&M on the same day as Chemo when it is to discuss the chemo this does not meet the requirements of the 25 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Thanks Debra.. I have very little experience with Oncology or chemotherapy. I stand corrected!
    Walker Bachman, CPC, CPPM

  5. #5
    Thanks so much for the quick replies!!

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