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25 Modifier on E&M with 94640, 94760 or 94200?

  1. Default 25 Modifier on E&M with 94640, 94760 or 94200?
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    Do you need a 25 modifier on 99213 with significant separately identifiable E/M done with 94640, 94760 or 94200?

  2. #2
    Jacksonville Florida Chapter
    That depends.

    If the patient came in and the doctor performed the 99213, and then decided to perform the 94640, 94760 or 94200 (doesn't matter if it's the same day or a different day), then no.... you wouldn't use mod 25 because that E/M service is a part of the overall service.

    If the patient came in for the 94640, 94760 or 94200, but something happened that the doctor though it was necessary to perform the E/M service after the others, then yes.... you would use mod 25.

    If the doctor is trying to claim the E/M service as an interpretation of the results from the 94640, 94760 or 94200, then you cannot use mod 25 because interpretation of results are included in codes 94640, 94760 or 94200.

    I hope this helps without confusing you.
    John Meyer, CPC
    Heekin Clinic

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