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Thread: Another modifier 25 case

  1. #1
    Join Date
    Apr 2007

    Unhappy Another modifier 25 case

    AAPC: Back to School
    Okay say for example a patient has an office visit almost every day. Patient everyday comes in complaining of abdominal pain. Every day the clinic is charging the following

    99213 25
    96360 iv infusion
    j2271 Morphine
    j2550 Promethaazine
    j3660 diazepam

    All visits have these same dx


    What I don't understand is how they can charge a 99213 25 every time. It doesn't appear to have any new symptoms and I mean they come in every day. The clinic tells me that they were told by Blue Cross rep they could use a modifier 25 on the E/M and get paid. Which they have been getting paid. It just doesn't seem logical to me or right why one could charge 99213 as well as the others if all the procedures are the same. Wouldn't they have to have an additional complaint to have a new e/m code everyday??
    Last edited by ebredehoeft; 08-13-2010 at 05:00 PM.

  2. #2
    Join Date
    Apr 2007

    Default Can anyone help me out with this Modifier 25 question

    This is quite the heated subject in the office and I need to get some input from some fellow coders please.


  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    is the treatment a planned treatment every day? if so then you cannot charge an ov. If it is not planned and documentation can support an ov that is over above and beyound an assessment necessary for the IV administration then yes you may charge with a 25 modifier.

    Debra A. Mitchell, MSPH, CPC-H

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