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modifier 25 - double check but

  1. #1
    Default modifier 25 - double check but
    Medical Coding Books
    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.

    Thanks

  2. #2
    Default
    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
    Location
    Nashville AAPC Chapter
    Posts
    937
    Default
    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:

    99233-25
    99291

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

    Examples:
    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. Exclamation Need to file claim please help
    our doctor wants to bill a 99396 99213 and 17000

    99396
    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.

    danielle

  7. #7
    Default
    Modifier 51 is not right in this case

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