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Modifier -25 (One E/M, One Procedure, One Diagnosis)

  1. #1
    Post Modifier -25 (One E/M, One Procedure, One Diagnosis)
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    I am getting mixed answers regarding a questin I have about using modifer 25.
    For example, If I bill the following CPT codes: 99212-office visit
    17110-Destruction of Lesions
    with Diagnosis code 078.19 as the only diagnosis, is it proper or not to add a modifier 25 to the 99212?
    In my opinion, even though there may only be one diganosis code, the physician may have evaluated other areas that there is no diagnosis for but an office visit is justified.

    What are your thoughts?

    Thanks!

    Kim, CPC
    kimberly.white@samcstl.org

  2. #2
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    The description of modifier 25 specifically states, "different diagnoses are not required for reporting of the E/M services on the same date." Hawever, be sure that the documentation is usfficient to show that the service was "above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed." In my experience, it rarely is.
    J G Stanley, MHA, CPC

  3. Default
    Quote Originally Posted by kwhite2008 View Post
    I am getting mixed answers regarding a questin I have about using modifer 25.
    For example, If I bill the following CPT codes: 99212-office visit
    17110-Destruction of Lesions
    with Diagnosis code 078.19 as the only diagnosis, is it proper or not to add a modifier 25 to the 99212?
    In my opinion, even though there may only be one diganosis code, the physician may have evaluated other areas that there is no diagnosis for but an office visit is justified.

    What are your thoughts?

    Thanks!

    Kim, CPC
    kimberly.white@samcstl.org
    If there is documentation to support the E&M and it is separately identifiable then of course you can. HOWEVER, if this patient was SCHEDULED to come in the office for the cryosurgery (or whatever procedure) then no you cannot charge for a visit unless another separate problem came up and the doctor had enough documentation to support the E&M with mod 25.

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