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25 modifier - clinican evaulated

  1. #1
    Default 25 modifier - clinican evaulated
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    Good Afternoon Coding World,


    Could I billed for EM if a clinican evaulated 2 pressure ulcer of the buttock , but debrided just one??

    eg: 99309 25 707.05 707.22
    11043 707.05 707.24

  2. #2
    Default
    Quote Originally Posted by coder1 View Post
    Good Afternoon Coding World,


    Could I billed for EM if a clinican evaulated 2 pressure ulcer of the buttock , but debrided just one??

    eg: 99309 25 707.05 707.22
    11043 707.05 707.24
    Not unless the key components of 99309 are documented (2 out of 3 of the following:
    Detailed interval history, detailed exam, moderate MDM). Simply looking at a second pressure ulcer in the same location as the one debrided, isn't enough on its own to warrant billing another E/M service. The E/M has to be significant/separately identifiable from the debridement to be reported.

  3. #3
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    Thanks for your prompt response...I agree 100% but in our clinican eyes "I should be reimburse for evaluating the second ulcer. The problem I have is finding edvidence to support that in this case the dx don't support the E/M

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