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-25 Modifier

  1. #1
    Default -25 Modifier
    Medical Coding Books
    A patient comes in the office with back pain, the physician evaluates the patient and decides to do an injection for the pain. Can the physician bill an E/M with a -25 modifier and the injection even though the only diagnosis for the visit is back pain.

    Thank you.

  2. #2
    Default
    Quote Originally Posted by amymorgan View Post
    A patient comes in the office with back pain, the physician evaluates the patient and decides to do an injection for the pain. Can the physician bill an E/M with a -25 modifier and the injection even though the only diagnosis for the visit is back pain.

    Thank you.
    Yes. It doesn't have to be a different diagnosis - he evaluated the problem, and made a decision on how to treat it, so an E/M is justified. Now, if he told the patient, "Come back tomorrow and get an injection.", you wouldn't be able to bill a separate E/M the next day, because all of the E/M work occurred on the day before. If the work's documented, then you can bill the code.

  3. #3
    Default
    Hello Brandi, for the above answer, would/could you add modifier 59 to the injection or would you let it stand alone?
    Thanks, Mysti
    Last edited by MTrujillo; 07-20-2011 at 06:47 PM.

  4. #4
    Default
    Quote Originally Posted by MTrujillo View Post
    Hello Brandi, for the above answer, would/could you add modifier 59 to the injection or would you let it stand alone?
    Thanks, Mysti
    AS long as it's just the injection and E/M, then no. Now, if some other procedure was done, like a trigger point injection, then you would need a 59 on the admin. But the -25 modifier on the E/M should take care of the injection admin and E/M bundle.

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