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is it ok to use modifier 25 on 99215 w/ 96360 hydration therapy?

  1. #1
    Melbourne, Florida
    Default is it ok to use modifier 25 on 99215 w/ 96360 hydration therapy?
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    Is it ok to use modifier 25 on 99215 w/ 96360 hydration therapy?
    Denise Gilrane-Pillow, CPB

  2. #2
    I would not put a 25 on the 99215

    I would try -59 on 96360

  3. Default
    I would say yes. You do use a 25 with any injections/infusions/hydrations as long as you have a separately identifible e&m

  4. #4

    Modifier 59 is the correct modifier.

  5. #5
    I would also use 25. I am curious as to why would anyone use 59?
    59 is used to identify procedures that are not normally reported together.


  6. Default
    Modifier 25 is the correct modifier to use in this scenario.

  7. #7
    Guidelines from the November 2001 edition of CPT® Assistant state, "Again, when reporting an E/M service on the same day as another procedure or service, modifier -25 should be appended to the evaluation and management service code. This will identify it as a significant, separately identifiable service above and beyond the other service provided or the usual preoperative and postoperative care associated with the procedure that was performed. The physician must also meet the key components listed in the code descriptor for a given level of E/M service."
    The Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (CCI) Policy Manual for Medicare Services supports this concept, as does CCI through various edits that include the E/M service in procedures that have a CPT guideline stating an E/M is only to be submitted if the E/M was a separately identifiable service as signified by modifier 25.
    So yes, mod 25 it is. =)

  8. #8
    Melbourne, Florida
    Thank you. I appreciate the discussions very much.
    Denise Gilrane-Pillow, CPB

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