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Modifier Question

  1. #1
    Daytona Beach
    Default Modifier Question
    Medical Coding Books
    What modifier would I use when a patient comes in for a shave biopsy, but at the same time receives her Enbrel injection that she brought in

    I was going to try 11300 25

    But everytime I look at other modifiers- I second guess myself. Please help!


    Heather D Unklesbay, CPC, MA
    Office Manager

  2. #2
    Default Modifier
    I believe the modifier 25 can only be used on Evaluation and Management codes. What about a modifier 59 to show it was a distinct service.

  3. #3
    Mod 25 only goes on E&M services.

    Becuase the 90772 is bundled into the 11300, you want to use modifier -59 on the 90772.

    It would be okay in this case because the injection was a different site and for a different reason.

    If the injection had been for local anesthesia for the primary procedure, then it would not be appopriate to use modifier -59.

    Hope that helps!


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