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Modifer -25 HELP!!!!

  1. #1
    Default Modifer -25 HELP!!!!
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    I am coding for a 99214 along with an urinalysis that was performed on the same encounter. The patient is coming for a followup for prostate cancer and is getting a urinalysis 81002.. Does the 99214 need a -25 modifer or would this be considered part of the evaluation?



  2. Default no 25 with 81002
    e/m and wellness exams

    we put 25, when we do a vaccine, injection, procedure, ekg, svn, pap,etc

    no 25 for 82270, 81002, glucose test,

  3. #3
    A lot of payers won't reimburse the UA with an E/M....mod or no mod.

  4. #4
    Okay thanks.. I know they don't reimburse but I thought that the E/M is paid at a higher level when you put the -25 on the claim and the UA is not reimbursed. Am I wrong?

  5. #5
    Sioux Falls South Dakota
    The -25 modifier is not for increasing reimbursement but to show that the E/M is a significant, separately identifiable E/M service from any procedure that was performed on the same date of service.

    Your reimbursement amount would be based on your contract with the third party payer, or the MPFS if Medicare.

  6. #6
    Thanks! :-)

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