My question is this: The below appear to contradict each other, here's how, if I am adding -25 due to a service, E&M or procedure by another QHP then that service will NOT be on my claim. Under the tips your definition states you cannot use -25 if you are only billing one line item..... So if I have an E&M on the same day as a service by another QHP what modifier is appropriate? Ex: primary care E&M on the same day as an x-ray reading, or the pt sees multiple providers on the same day (previously we used -25 for the subsequent E&Ms but according to below we cannot do that and modifier 76/77 are not E&M appropriate).
Modifier 25: (Copied the descriptor) Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
Under Tips: Although the news that all procedures contain a minor related E/M service might surprise you, you probably know that modifier 25 submissions require a minimum of two codes. However, auditors tell the Insider that not all coders are aware of this, and that they occasionally see modifier 25 on claims when an E/M visit was the only service reported. Without an accompanying initial service or procedure, you can't have a significant, separately identifiable service, experts say. When submitting claims consisting solely of an E/M code, make sure you don't include modifier 25.
Modifier 25: (Copied the descriptor) Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
Under Tips: Although the news that all procedures contain a minor related E/M service might surprise you, you probably know that modifier 25 submissions require a minimum of two codes. However, auditors tell the Insider that not all coders are aware of this, and that they occasionally see modifier 25 on claims when an E/M visit was the only service reported. Without an accompanying initial service or procedure, you can't have a significant, separately identifiable service, experts say. When submitting claims consisting solely of an E/M code, make sure you don't include modifier 25.