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ov with modifier 25 and injection

  1. #31
    Medical Coding Books
    This is the article from the AAFP...

  2. #32
    Question OV Preventive visit & vaccines

    January CCI edits have changed the indicator to "1" modifer needed on preventive vists and other E/M visits:
    99201 thru 99205 E/M visit new patient
    99212 thru 99215 E/M visit established patient
    99241 thru 99245 Office consultation
    99251 thru 99255 Consultation Inpatient
    99281 thru 99281 Emergency department visit
    99381 thru 99387 Preventive medicine visit
    99391 thru 99397 Preventive medicine reevaluation visit
    99401 thru 99409 Preventive counseling services
    99411 thru 99412 Preventive counseling service group setting
    99420 Administration and interpretation of health risk

    when these codes are billed on the same day with:
    CPT 90471 & 90472 immunization admin w/o counseling & each additional vaccine
    CPT 90473 & 90474 immunization admin intranasal or oral & each additional vaccine
    CPT 90460 & 90461 immunization admin w/counseling & each additional vaccine

    In Pediatric practice sometimes patient is billed preventive and sick E/M code and vaccines on the sameday according to CCI edits both visits need a modifier 25. Not sure what to do in these cases, never billed this way before. Does not seem correct. Need some input and ideas.

  3. #33
    This is what i came up with, as well. I am equally confused. It just doesn't make logical sense to require the modifier on both the exam AND the office visit codes, especially when they are together. We often see patients for preventive, vaccine, and chronic disease appts at the same time, also. I am trying to send a few claims this way and waiting to see if insurance pays or not. I will certianly post what I come up with, but would be thrilled if somebody else comes up with something first!!

  4. Default Pain management billing
    I am having and issue with AL bcbs we are billing an established E/M with and injection and they are paying the injection and stating the E/M is bundled. There is a mod 25 on the E/M. I am new to billing for pain management can we not bill and e/m with and epidural injection on same date of service or is there another modifier that I should be using.

  5. #35
    Are the DX codes linked appropriately? I would make sure that the E/M code has a differant DX than the injection (AND also has the modifier 25). The modifier is indicating that the E/M is for a separately identifiable E/M service.

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