Results 1 to 2 of 2

OBGYN Modifier 25 Question

  1. Question OBGYN Modifier 25 Question
    Medical Coding Books
    Can someone please help. Patient comes in with suspicion of being pregnant. OBGYN does the exam to determine pregnancy then does an ultrasound to determine viability. When billing if you don't use the 25 modifier on the e/m the ultrasound gets paid and the e/m gets denied as bundled. My contention is there is more taking place than the limited amount of e/m related to the ultrasound and thus both codes should be paid. Anyone have any ideas or places where I can find some documentation?


  2. Default
    If the patients insurance is a MediCaid type policy the program will only pay for the ultrasound. For other insurances, a non pregnancy diagnosis is required to justify the visit portion, such a something pertaining to her menses. Appeal denial with medical records.

Similar Threads

  1. OBGYN Question
    By dcourtney in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 12-29-2011, 08:03 AM
  2. OBGYN question
    By alisan in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 10-04-2011, 01:24 PM
  3. Desparate:OBGYN question
    By howardi in forum OB/GYN
    Replies: 2
    Last Post: 04-10-2009, 07:08 AM

Tags for this Thread

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.