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modifier 25

  1. Question modifier 25
    Medical Coding Books
    I need to know other peoples opinion on this. If a patient comes in with a new lesion and you decide to do a procedure (with global days) that same day, then can you charge for an office visit and put a modifier -25 on the office visit or do you feel like thats part of the procedure?

  2. #2
    Coastal Coders
    Our doctor spends more time on the evaluation than doing a biopsy so we usually bill the visit with a 25 modifier and then the biopsy.

  3. #3
    You can bill for both with the 25 mod on the visit but also use separate Dx codes for each CPT.

  4. #4
    I don't feel you necessarily have to use different Dx codes per CPT in this case. If the biopsy or excision was planned, then yes, the office visit could only be billed if it was "significant, separately identifiable," from the other procedure (related to different diagnoses).
    However, lets look at a new patient visit. The patient comes in, full workup is done, and the decision is made to remove a suspisious lesion on the thigh. Since modifier 57 is only appropriate for 90-day global surgies, we would use a modifier 25. The full workup is more than enough to support the office visit charge. The visit was not only focused on this one lesion or one body area.

    ~Melanie, CPC~

  5. #5
    Columbia, MO
    In the CPT book under the 25 modifier in Appendix A it states that different diagnosis are not required for appropriate use of this modifier. Al you need id the documentation to be clear that the visit was not planned for the procedure and the assessment exceeds the parameters of what is normally inclusive for the procedure. An assessment of the affected area to be excised is inclusive to the procedure.

    Debra A. Mitchell, MSPH, CPC-H

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