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Thread: modifier 25

  1. #1
    Join Date
    Apr 2007

    Default modifier 25

    AAPC: Back to School
    I just want to double check but it is my understanding that modifier 25 can only be put on the E/M code and not the other codes billed with the E/M code. I have a clinic that is putting 25 modifier on all but the e/m code. So I want to make sure I am telling them correctly.


  2. #2
    Join Date
    Apr 2007


    Let me rephrase that last sentence. I am wanting to tell them they can only put the 25 on the e/m code itself not the others.

  3. #3
    Join Date
    Apr 2007
    Nashville AAPC Chapter


    You are absolutely correct. The 25 modifier states that there is a seperately identifiable E/M with a surgical procedure.

    There are instances where a 25 modifier is appended to another E/M code. Fore example when a patient is inpatient status and is seen in the am by the hospitalist then goes critical later in the afternoon. You would bill this incidence like this:


    But, you cannot bill a followup inpatient CPT code after critical was given prior in the day, you can only bill the critical care.

  4. #4


    Quote Originally Posted by ebredehoeft View Post
    Let me rephrase that last sentence. I am wanting to tell them they can only put the 25 on the e/m code itself not the others.
    Is putting Modifier 25 on strep and Ua in house tests correct

  5. #5


    Mod -25 is an E&M modifier not a CPT modifier

    99213-25 OV
    93000 EKG

    99396 routine preventive OV
    99212-25 separate identified/eval problem

    99232-25 subsequent hosptil visit
    93510-26 left heart cath (did not list the usual addtional cath codes)

    Most important is that for each E&M with mod -25 the documentation must support that a significant separate E&M service was provided in addition to the other coded/billed service the same day

  6. #6

    Exclamation Need to file claim please help

    our doctor wants to bill a 99396 99213 and 17000

    99213, 25
    17000, 51

    Giving that I audit and find that the documentation supports the additional office visit, would this be the way to code this. I tell them all the time do not do this and they do not listen.


  7. #7
    Join Date
    Apr 2007


    Modifier 51 is not right in this case

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