AAPC - Back to school
Page 1 of 2 12 LastLast
Results 1 to 10 of 11

Thread: Modifier 25

  1. #1
    Join Date
    Apr 2007

    Default Modifier 25

    AAPC: Back to School
    Hi All,

    It would be great if anyone an provide examples and scenarios on Modifier 25.

    Thanks in advance for your help.

    Mira,CPC,CPC-H, CPC-P

  2. #2


    Well Woman Exam W/ Problem Visit...


    99213 -25

  3. #3

    Default -25

    A parent takes a 9yr old to the child's physician for an oral poliomyelitis vaccine. The physician's assistant evaluates the child (established pt) & administers the vaccine orally to the child.
    90473 (Immuniz. Admin.,One Vaccine/Toxoid)
    99211-25 (Eval. & Mangmnt.)

  4. #4

    Default -25

    Photochemotherapy is provided for a 34 yr old consultative pt w/ severe dermatosis. The pt receives 8 hrs of treatment. The physician provides a comprehensive history & physical exam w/ moderatley complex medical desicion making.
    99244-25 (Consultation,Office &/or Other Outpt)
    96913 (Photochemotherapy)
    Last edited by christyms; 10-25-2008 at 03:37 PM. Reason: forgot code descriptions to help out

  5. #5

    Smile -25

    Modifier -25 is used to report an E/M service on a day when another service was provided to the pt by the same physician. Or, if a pt came into the office for a visit early in the day & then later in the day needed to return for a separate service, you would report both services using E/M codes & add -25 to the second code.
    Modifier -25 requests payment for both E/M & a minor procedure or two E/M services on same day.

  6. #6


    What type of service was rendered during the second encounter? a procedure or an E/M?
    If it was a 2nd E/M, my suggestion would be to charge one E/M for the whole day but to increase it's level of service (to a level that documentation supports).
    If the patient returned the same day for a procedure or service other that E/M, charge 1 E/M with mod. 25 and than the procedure/service (increase the level of the E/M if the documentation supports it).
    I am not sure that any insurance will pay for 2 visits on the same day, regardless that they were for 2 separate issues......

    CT ENT

  7. #7


    I am sorry, I apparently had cranial flagylation when reading and responding to this........

    Confused in CT.......)

    CT ENT

  8. #8
    Join Date
    Apr 2007
    Stuart Sailfish Chapter


    Pt presents to the office as a New Patient. CC Sinus Congestion. MD performs a Complete physical exam. addressing areas of the sinus, reviewing Ct scans etc.
    upon physical exam he notices patient has cerumen impaction and debrides the cerumen

    99203 -25 Dx 478.19
    69210 Dx 380.4

    The 99203 was a distinct seperately reported E/M during the same session as a procedure
    Candice Fenildo, CPC, CPMA, CPB, CENTC, CPC-I
    AAPC Chapter Association Board of Directors ( Chair)
    Region 6, Wisconsin, Minnesota, Illinois, Indiana, Michigan, Ohio

    "Nothing is stronger than the heart of a volunteer"

  9. #9
    Join Date
    Apr 2007

    Default 25

    Hi All,

    Thank you so much.

    Mira,CPC,CPC-H, CPC-P

  10. #10
    Join Date
    Apr 2007


    Is anyone billing for Wound Care Centers? These are recurring patients usually returning once a week - the doc says he must evaluate the wound before deciding for certain if another debridement is required. Based on this I have been billing the E/M level documented w -25 then the debridement. However today we had a meeting with the reimbursement director over the WCC who advised that we could only bill for both if there was another medical reason for the E/M or if a new wound was present. I thought the -25 could be used as a decision for surgery for minor procedures (0-10 day global). Is that incorrect?
    Mary Beth Gord, CPC

Page 1 of 2 12 LastLast

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 01:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 12:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 07:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 12:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 03:59 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.