It is a general misconception that a 25 modifier is needed for new patient E/M codes when other procedures are being performed on the same day. it is not, however, necessary. This is per many sources but the one that I taking the text below from is: www.medicarenhic.com/cal_prov/articles/modifier25_1006.htm[/url]
The exception is that if a NEW patient E/M service is explicitly bundled to the procedure by an NCCI edit. In that case, a 25 modifier would be appropriate.
This is not to say that you will not have inapproptiate denials from payers when a procedure is done on the same day as an E/M visit. I have found that attaching a copy of the modifier guidelines with the claim upon appeal usually works. Not that any of us have time to prepare appeals on claims that are denied in error!!!
.................................................. .................................................. ..
SPECIAL USAGE GUIDELINES
New patient E/M. A new patient E/M service, as defined by CPT, is, by its very nature, considered to be a significant, separately identifiable evaluation and management service when documentation guidelines for the E/M service are met. A new patient E/M service does not need to have a modifier -25 appended when a minor procedure/surgery (global period: 000 [same day only] or 010 [10 days]) is performed on the same date. Therefore when billing any global procedures/surgeries, including foot care codes (CMS dropped the NCCI edit), modifier -25 does not need to be appended to the new patient E/M service code.
If the new patient E/M service is explicitly bundled to the procedure by an NCCI edit, then use modifier -25, when the new patient E/M service has a significant, separately identifiable component(s).
Hope this helps
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join