AAPC - Back to school
Results 1 to 2 of 2

Thread: Modifier 25 usage in wound clinic

  1. #1

    Default Modifier 25 usage in wound clinic

    AAPC: Back to School
    Is it appropriate to bill a facility E/M (99211) on every visit in a wound clinic regardless of a procedure being done or not?

    The clinic is a hospital outpatient department and is billing every patient 99211 and adds modifier 25 if a procedure is done (this is for the facility charges). The physician's charges are entered separately.

    My understanding is that this is not appropriate to do, as a matter of practice, on each and every visit unless the E/M is separately identifiable. But I am wondering if there may be some different rules where this is a facility charge.

    The clinic manager argues that we are charging for our nursing/facility resources for each visit that are not specifically related to the procedure (vitals, review of history etc.). My argument is that these are not separately identifiable and are considered included in the facility payment for the procedure.

    Established patient returns for wound debridement
    Facility charges: 99211-25, 11040
    Physician charges: 11040

  2. #2
    Join Date
    Apr 2007
    Central Indiana


    We have patients that come in for Unna boots and had previously been charging 99211-25 with the Unna boot code. I am in agreement with you that it is inappropriate to do so. Unless they have documentation of an additional problem at the time, the purpose of the visit is the wound care. You should not charge separately for vitals being taken.

Similar Threads

  1. 62 modifier usage
    By AESCPC in forum Modifiers
    Replies: 3
    Last Post: 04-21-2014, 02:37 PM
  2. Wound Clinic Modifier
    By hrange in forum Modifiers
    Replies: 0
    Last Post: 11-04-2010, 01:37 PM
  3. modifier 76 usage
    By Pillow1 in forum Cardiology
    Replies: 0
    Last Post: 01-12-2010, 02:11 PM
  4. Modifier 25 in Wound Clinic
    By cbooker in forum General Surgery
    Replies: 1
    Last Post: 06-10-2009, 07:21 AM

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.