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Can I use modifier 25 with preventive medicine and E/M same date of service

  1. Default Can I use modifier 25 with preventive medicine and E/M same date of service
    Medical Coding Books
    is

    93985-25
    99214-25
    10060

    is correct
    Vikas Maheshwari
    Operation Manager (Medical Billing & Coding)
    MBA-HCS, CPC-H

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by Vikas Maheshwari View Post
    is

    93985-25
    99214-25
    10060

    is correct
    For your scenario you would use the 25 on the 99214 only HOWEVER it is an issue to use a level 4 ov with a preventive, a level 4 is a very intense encounter and as such may indicate the patient is too ill to be subjected to a preventive encounter at this time. The AMA last year had a memo on their website that suggested the ov should be a level2 when combined with a preventive. I agree this makes good sense.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Agree with Debra above. Our state regulations will not pay for an E and M above level 2 when billed with preventative medicine.

  4. #4
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    Nashville AAPC Chapter
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    937
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    Emergency Departments do not use 99214 codes. This is not appropriate as all patients coming in to the ED are NEW patients. The visit would entail a workup and NOPP based on all of the problems being treated.
    A 99285 are High Risk E/M levels and probably not appropriate for this scenario since there isn't a life-threatening level of workup needed.

    DO not use a 99214 in an ER setting - proffessional side or facility.

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
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    Quote Originally Posted by mworcester View Post
    Emergency Departments do not use 99214 codes. This is not appropriate as all patients coming in to the ED are NEW patients. The visit would entail a workup and NOPP based on all of the problems being treated.
    A 99285 are High Risk E/M levels and probably not appropriate for this scenario since there isn't a life-threatening level of workup needed.

    DO not use a 99214 in an ER setting - proffessional side or facility.
    I believe she meant 99385 not 93985 as she was referring to a preventive visit level with an ov level on the same day, not an ER 99285 visit at all.

    Debra A. Mitchell, MSPH, CPC-H

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