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Modifier 25

  1. #1
    Default Modifier 25
    Medical Coding Books
    If a patient presents to the clinic for debridement (scheduled appointment), the patient is evaluated, the physician (professional services) debrides the wound, the nurse (hospital based nurse in hospital clinic) dresses the wound and the patient is sent home (established patient). Can the hosptial charge an EM in addition to the wound care?

  2. #2
    Columbia, MO
    The rules for the hospital are very much like the provider, if the facility expended resources beyond what is required for the procedure then yes you may use and E&M level with the 25 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default Thanks
    That actually clears it up some. They performed an office visit, billed a level 214 with Modifier 25 but it was not documented beyond what was medically necessary for the procedure.

  4. #4
    Columbia, MO
    If that is the case then the visit level should be removed.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5

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