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Thread: modifier 25

  1. #1

    Default modifier 25

    AAPC: Back to School
    HELP!! Dr did a brief E/M, and an injection, now......he used a mod. 25 w/E/M, but pt has been in before for an injection....2 injections actually but last injection 5 mos. ago. Can I used the modifier??????


  2. #2
    Join Date
    Apr 2007


    If pt is getting injection for same body part that has been evaluated before- with no new inury- then the answer is nooooo, you cannot bill E/M.

    Look at the definition of your mod "significant, separately identifiable"- I think the definition alone should convince your doc.

  3. #3


    Thank you....I didn't thinks so....I just needed to know that I was right on that.

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Maybe ...

    If the reason for the visit was to receive the injection (i.e. it was previously scheduled) then, NO, you cannot charge for the E/M (unless some completely diffferent issue was evaluated).

    However, you state the last injection was 5 months previous. Was the patient released from treatment at that time? Was this a new problem or even a recurrence of a previous probllem?

    If at the last visit the physician had no intention of seeing the patient again for the problem, then it would be reasonable for him to have to evaluate the injury/disease process to determine a course of treatment (which, in this case, would be the injection). If that is the case, you might be able to use the -25 modifier. It will all depend on the documentation (what else?).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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