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Thread: 2 E&M's w/ mod 25

  1. #1
    Join Date
    Apr 2007
    Kachina Coders

    Default 2 E&M's w/ mod 25

    AAPC: Back to School
    My manager belongs to a managers list serve thru a local hosp and there is talk on it that they are doing the following and getting paid for it:

    99391-25 V20.2
    99213 382.2

    I always thought that the modifer 25 goes on the "sick code" - which way is the proper way to code- we have been coding it the other way.

    Thanks for you help in advance

  2. #2
    Join Date
    Apr 2007
    Duluth, Minnesota


    I agree with you Kathy - I would have it reversed -
    99213.25 - 382.2
    99391 - V20.2
    (documentation supporting BOTH services of course)

    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  3. #3
    Join Date
    Apr 2007
    North Carolina


    I have copied this directly from UHC's website. Mod 25 does go on the problem oriented E/M code.

    "A Preventive Medicine CPT or HCPCS code (99381-99397, G0344) and a problem-oriented E/M CPT code from the following code series only--99201-99205, 99212-99215--may both be submitted for the same patient by the same specialty physician or other health care professional on the same date of service. If the E/M code represents a significant, separately identifiable service and is submitted with modifier 25 appended, UnitedHealthcare will reimburse the Preventive Medicine code plus 50% of the problem-oriented E/M code. UnitedHealthcare will not reimburse a problem-oriented E/M code that does not represent a significant, separately identifiable service and that is not submitted with modifier 25 appended."

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