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EM with 25 and 31231

  1. Default EM with 25 and 31231
    Medical Coding Books
    Bundling tool shows 99214 bundles with 31231. Is it appropriate to add 25 modifier?

  2. Default
    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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