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Thread: mod 25 with 90772?

  1. #1
    Join Date
    Apr 2007
    Bay City

    Cool mod 25 with 90772?

    AAPC: Back to School
    What are the Medicare guidelines on using a mod 25 on and E/M along with 90772? Do you have to have more then one diagnosis to be able to bill an E/M with 25 mod? Where can I find this information to share with others?


  2. #2
    Join Date
    Apr 2007
    Woodbridge, VA


    You do not need a separate diagnosis for the E/M and the injection codes (does not apply to 99211 as the payment for this E/M is included in the injection code). The information can be obtained from the Medicare Claims Processing Manual (Chapter 12, Section 30.6.7): "Medicare will pay for medically necessary office/outpatient visits billed on the same day as a drug administration service with modifier -25 when the modifier indicates that a separarately identifiable E/M service was performed that meets a higher complexity level of care than a service represented by CPT code 99211...For an E/M service provided on the same day, a different diagnosis is not required."

    Zaida, CPC

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