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Thread: Use of mod -25 with new pts

  1. #1
    Join Date
    Apr 2007

    Default Use of mod -25 with new pts

    AAPC: Back to School
    Does anyone know if there is documentation anywhere stating that you cannot use a mod 25 on an E&M if it is a New patient visit, when an add'l procedure was done?
    For example, pt made appt with chief complaint of dark, painful, itchy patches on his arm & face. Provider does all elements of E&M, and part of his MDM is to do a punch bx of the skin abnormalities. He documents the bx's separately.
    The dr I work for was told by a consultant that the 25 cannot be used in this case. Any ideas
    why not?

  2. #2


    yes you can use a modifier 25 as long as you have a separately identifable E&M and with a new patient, I would assume you do.

  3. #3
    Join Date
    Apr 2007
    Nashville AAPC Chapter


    I am sure what the consultant was talking about is that minor procedures (global days betwee 0-30) have the E/M bunled into it if that is the only area they are examining. There has to be a totally separate or significant E/M in order to bill for it.

    If that is the only complaint, and they do not do x-ray's or labs or discuss surgery options - then there is no E/M allowed. It is bundled into the punch biopsy.

    Whether the patient is new or established is irrelavant.

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    If the docuemntation allows that a significant examination were performed then yes you can use the 25 modifier. A significant examine is one that is over above and beyond that which is needed to perform the service. in order to do the bx he must examine the areas in question, now what else does the documentation say? Does it go into detail about other areas of the body being blemish free? So in otherwords is a full body skin exam performed to look to see if anything else looks suspicious? if so then you have what you need for the exam to be billed with the 25 modifier, make sure he also documents the procedure as procedure note in a separate paragraph. You do not need 2 dx codes in order to use the 25 modifier and be paid with it. That is a myth!

    Debra A. Mitchell, MSPH, CPC-H

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