Results 1 to 4 of 4

modifier 25?

  1. #1
    Default modifier 25?
    Medical Coding Books
    (for the Physician)
    Pt seen originally 6/3/10 99214-25, 10160

    Returns 6/7/10 99204, 10160-58,76 (Physician had to repeat the aspiration, not due to any complications)

    Returns 6/14/10 99204, 19020-58 (physician performed a more extensive procedure on the same site)

    Do I attach mod 25 to the post op 99024 (even tho' mod 25 is for E/M)? Also, can my doctor bill for these procedures done on the same site without mentioning any compllications?

    Any assistance would be greatly appreciated.

  2. #2
    Kansas City, MO
    You dont need a 25 on the 99024, since it is a non-billable (zero-charge) code.

    I dont really see the need for the -76 either. Usually this is used for a "same day" situation.

    for your additional procedures you're gonna want to use 58 (planned or related) or 78(unplanned - usually a complication)

    He can bill for them if they are done...doesn't necessarily require a "complication", but he should document in his notes why each additional procedure was done.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC, AAPC Fellow
    PMCC Licensed Instructor
    2018 Chapter President, Kansas City, MO

  3. Default
    99024 is a CPT code and not an E&M code. Mod -25 is not used on 99024 or any other CPT code. 99024 basically says "I have no billable E&M service"

    The documentation should support the medical necessity for each of these procedures and the specifics of what was performed. If the 19020 was done due to complications then the documentation should support that and there are some 998.xx range of DX codes for complications that could be coded

    I disagree regarding the use of -76. I have not seen any written guidelines stating "same day". I do agree that the documentation and reason for these f/up procedures determines the modifier -58 or -76 or -78 as the most appropriate
    Last edited by sbicknell; 06-14-2010 at 01:20 PM.

  4. #4
    Many thanks the help from both of you

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 01:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 12:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 07:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 12:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 03:59 PM

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.