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Consult with procedure (Help)

  1. Default Consult with procedure (Help)
    Clearnace Sale
    I have a provider that states that at her last practice they charged her consult fee and EMG without using a modifier. I thought you had to add the 25 and that actually the fee was reduced. Please give me your experiences or thoughts. Thanks!!


  2. #2
    Default To broundy-Consult with procedure (Help)
    Technically a consultation should not require a modifier simply because of the nature of the service. In reality, there are several payers that do require it to be appended to the E&M code when it is reported on the same date as a procedure/diagnostic test, etc.

    I would be more concerned that the E&M service actually meets the criteria to be reported with a consultation code.

    For example, a family medicine provider requests a diagnostic test from a specialist via an order for an EMG study and instead the specialist bills a consult in addition to the diagnostic test. In this scenario there is no request for a consultation so it would be wrong to report a consultation. Part of the EMG service is to issue a report which contains the findings and recommendations. A consult is designed to provide similar information. For this reason it seems unacceptable to bill for an EMG and a consultation the same evaluation. Of course there are always exceptions and based on what information you provided, my educated “opinion” is that the provider should not report a consultation and an EMG at the same time. I am pasting the link to an interesting article regarding EMG documentation and reporting. I hope it is helpful.
    Mickie Kummer, CPC, CPMA, CRC, CPC-I, AAPC Fellow

  3. Default Consult and procedure
    Thank you for your reply. I do understand what you are saying and I did not explain this very well I am afraid. She does meet the criteria for the consult and decides many times at the consult that testing is needed, so she does it on the same day. Am I wrong in thinking that when you add a 25 modifier the payment is reduced? I am not sure where I got this information but it is stuck in my head Thanks again for any help! Bonnie

  4. #4
    Milwaukee WI
    Default 25 does NOT reduce payment
    The -25 modifier does not reduce payment. In fact, it allows for payment for the "Significant, separately identifiable" E/M service on the same date as a minor procedure.

    F Tessa Bartels, CPC, CEMC

  5. #5
    I agree that modifier 25 does not reduce payment, it's quite the opposite. Maybe you were confused with the 52 modifier?

    Happens to the best of us !!!

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