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Modifier 25 in ER on UB04

  1. Default Modifier 25 in ER on UB04
    Medical Coding Books
    Should modifier 25 be appended to ER E/M CPT code range 99281-99285 with revenue code 450 when there are other procedures done on the same date on a UB04 form? For example:

    99284 with revenue code 450
    96372 with revenue code 450
    70450 with revenue code 320

    All these services were rendered on the same date.

  2. #2
    Location
    Columbia, MO
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    yes you will need a 25 modifier on the E&M any time there is a status S or T procedure performed in any session of the day. So if you have a 510 99213 and a 450 99284 with the 450 99372 on the same date of service then both E&Ms will need a 25 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Quote Originally Posted by mitchellde View Post
    yes you will need a 25 modifier on the E&M any time there is a status S or T procedure performed in any session of the day. So if you have a 510 99213 and a 450 99284 with the 450 99372 on the same date of service then both E&Ms will need a 25 modifier.
    Could you please clarify what are S or T procedures? If there's only radiology services rendered along with ER E/M, should the modifier be appended to the ER E/M?

  4. #4
    Location
    Columbia, MO
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    you will need to check the status indicator, either S or T are significant procedures which will require a 25 on the E&M. Some Radiology procedures have a status indicator of S a few have a T and some have an X which is not significant. I do not have a list in front of me but as I remember chest xrays are a status X but ultrasounds are an S as an example. If you have an encoder such as 3M then it should tell you the status indicator when you pull up the code.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    What if there's a professional fee on the same hospital bill? For example:
    450 99283
    350 72125
    981 99283

    Do we append 25 to both of the ER E/M?

  6. #6
    Location
    Columbia, MO
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    Yes if 72125 is a status S or T

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Fort Smith, AR
    Posts
    42
    Default Status Indicator
    I was about to most a new thread and found this that is very similar. I am used to using the rule that if a S or T status indicator charge is present then modifier 25 should be added. Begining Jan 1st they have changed the payment method on alot of radiology and these now have status Q3. Does the modifier still apply? And I need to know where I can find that from a "prove it" type if possible. Has anyone else had any problems?

    For example the new CT scan codes are Q3 74177 & 99284

    or 99285 & 70450 (Q3)

  8. #8
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    Columbia, MO
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    STVX-packaged codes” (SI “Q1”) are packaged if they are billed on the same date of service with any other code with an SI of “S,” “T,” “V,” or “X.” If not, they are separately payable under a separate APC. “T-packaged codes” (SI “Q2”) are packaged only if they are billed on the same date of service with any other codes with an SI of “T.” If not, they are separately payable under a separate APC. Codes subject to payment as part of a composite (SI “Q3”) are packaged into the composite rate when all criteria for that composite are met. Otherwise, the services with SI “Q3” may be separately payable if otherwise assigned to a separate APC or packaged into other services, if not.

    If more than one “STVX-packaged” (“Q1”) or “T-packaged” (“Q2”) code is reported without a separately payable service into which it would otherwise be packaged, separate payment is made only for the highest paying among them, and all others are packaged into that code. If any SI “Q1” or “Q2” codes are reported on the same day as any code that is subject to composite payment (“Q3”), and payment criteria are met for composite payment, the “Q1” and ”Q2” codes will be packaged into the composite payment.
    The Q3 has to do with packaged services and payment, therefore yes you will still need the 25 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Default
    Does this mean that 25 modifier should not be used on an E&M if it it also billed with a procedure with a Q1 modifier?
    N. Aaron

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