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Thread: Modifier with G0438

  1. #1
    Join Date
    Apr 2007
    Bentonville, Arkansas

    Default Modifier with G0438

    AAPC: Back to School
    My doc saw a patient for several issues (99214-25) and also did the Medicare Wellness (G0438). In addition he did a trigger point injection (20550) and tobacco cessation counseling (99406). I know the modifier -25 is necessary, but the edit on my sofware is telling me there is another modifier that is missing, and I don't know which modifier that would be and where to place it. Any suggestions?

  2. #2
    Join Date
    Apr 2007


    is the edit on the G0438? you may have to put a 25 on that as well.

  3. #3
    Join Date
    Apr 2007
    Kansas City, MO


    You would not put a 25 on the G code. 25 is for e/m codes only.

    As for what your system says is missing...I don't see it.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  4. #4


    Try -76 on 99406

  5. #5


    Or you could try a 59 on 99406

  6. #6
    Join Date
    Apr 2007
    Columbia, MO


    It would have to be a 59 for the 99406, definitely not a 76 as there is no repeated service. Be aware though that they may still bundle the 99406 into the 99214. Also I believe Medicare has a G code for smoking cessation counseling which is what you would have to use. Be sure that the documentation forthe smoking cessation is completely separate and apart of any issue related to the 99214 and is not include in the time assessment of the 99214. They payers love to bundle this and it is hard to appeal and win if the documentation is not perfect.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7


    If an E/M service code (99201-99350) is reported in addition to a code from the 99381-99397 and/or 99401-99412 series, modifier 25, Significant, separately identifiable E/M by the same physician on the same day of the procedure or other service, should be appended to the appropriate level E/M service code. Modifier 25 is reported to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant and separately identifiable E/M service above and beyond the other service provided. Documentation should justify a significant, separately identifiable E/M service for the respective E/M level along with the said code 99406.

    But, trigger point injection 20550 has also been performed, for which we can also use modifier 25 with 99406.

    Sanjit K Mishra, CPC
    Last edited by Sanjit; 06-27-2011 at 11:34 AM.

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