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Thread: EM with 25 and 31231

  1. #1

    Default EM with 25 and 31231

    AAPC: Back to School
    Bundling tool shows 99214 bundles with 31231. Is it appropriate to add 25 modifier?

  2. #2


    Yes, you can use -25. However, you need to make sure that you can show Significant, separately identifiable E/M in order to use. Remember, If a code has a global period there is already some reimbursement for E/M built into the code.

    The way I look at it is, if a patient walked into the office you are not going to just put a scope up their nose. There has to be some E/M to make sure you actually need a scope and to make sure it's appropriate. If the E/M is outside of what is needed to do the scope you should be OK to use -25. With that said, you'll still need to show medical necessity for the extra E/M and you'll need to "carve out" the E/M for the scope to bill the appropriate E/M Level.
    Last edited by Lujanwj; 12-15-2011 at 12:56 PM. Reason: added info

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