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Modifier 25 with "Medicine" CPT Codes

  1. #1
    Default Modifier 25 with "Medicine" CPT Codes
    Medical Coding Books
    Does anyone have information on if you should attach mod 25 to an E/M code, when the other service is from the Medicine section of CPT?

    For example, do you use it with an EKG? a refraction? a pulse ox?

  2. #2
    Milwaukee WI
    Default Yes
    Yes, -25 mod is added to the E/M code to identify: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service (emphasis added by me; but description is straight from Appendix A of CPT 2008 Professional Edition.

    But coding it correctly w/ the modifier doesn't mean it'll get paid.

    Have a good weekend!
    F Tessa Bartels, CPC, CPC-E/M

  3. Default Yes
    Yes, modifier -25 can be appended to the E/M code, when the other service is from the medicine section of CPT. Provided, it is a significant & separately identifiable E/M service done by the same physician on the same day of the procedure.

    Thanks & Regards,
    Jaisheela Padmanabhan, CPC
    Last edited by jaisheela; 07-20-2008 at 08:09 AM.

  4. Default
    If you are billing for Medicare, it will accept Modifier 25 with an E/M along with a procedure that carries 0 or 10 global f/u days. For majority of the Medicine section procedures, global is not applied (XXX) and no need to append Mod 25 with an E/M. For other payors, we can append modifier 25 if the E/M provided along with fits the bill.
    Jagadish, CCS-P, CPC

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