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Modifier 25

  1. Default Modifier 25
    Medical Coding Books
    I am trying to comply with the CMS NCCI edits and have recently gotten a denial. A client came in for a 90846 and a few hours later for a 90806 - 2 appointments in the same day, but a different procedure code. Medicaid said I could try a modifier, but I am slightly confused as to which I should use. Would I used the modifier 25 - for significant, seperately identifiable evaluation and management service by the same physician on the same day of the procedure or other service? Both services were provided by the same clinician, but I know those codes do not fall under E/M codes. Any suggestions?

  2. #2
    Hello, you would not use a 25 modifier due to you did not have an office visit. I would use a 59 modifier attached to the 2nd procedure since it is a completely different procedure..
    were these procedures done in the office or surgery?? If the patient was returned to the OR then you would use a 78 (returned to OR for a related proc) or 79 return to OR for an unrelated proc. Hope this helps.

  3. Default
    Thanks for the help. These procedures took place in the office, so I do not need to do any OR codes. Thanks again!

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