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Em code and modifiers

  1. Default Em code and modifiers
    Medical Coding Books
    i was told that modifier 25 must be attached to em code if labs are done. I have never done this and medicare has always paid for both the em and labs. Does anyone else use the 25 modifier when billing em codes and labs?

  2. #2
    Default Mod 25 and labs
    I have never used a modifier 25 with an e/m when only doing labs and i always get paid. I use the mod 25 when doing e/m plus a procedure like 96372, 94640 or 17110 etc. Hope that helps! :d

  3. #3
    Maple Grove, MN
    You may want to verify with each of your payer plans as they all seem to have different rules. In MN, we are not required by any of our payers to add modifier 25 to the EM when done with a lab.

  4. Default
    I agree but some payers want a -25 anytime an E&M and CPT are coded together. But think of it this way............

    It is probably unlikely the physician would perform the 80000 lab test so mod -25 is not needed.

    It is probable the physician would also perform the diagnosistic test (ie 93000, 94060, 17110 etc ) so the mod -25 is needed to show he did a significant separate E&M service in addition to the diagnostic

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