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99285 w/Modifier 25

SuperCoder Posted Wed 20th of April, 2011 01:26:26 AM

Hi!
In what circunstances Mod. 25 should be used with 99285?
Thanks

SuperCoder Answered Wed 20th of April, 2011 05:37:46 AM

Modifier 25 indicates that significant , separately identifiable E/M service by the same physician on the same day of the procedure or other service. Medicare requires that modifier -25 always be appended to the (ED) E/M code (99281-99285) when provided on the same date as a diagnostic medical/surgical and/or therapeutic medical/surgical procedure(s). Giving you some examples.

Example #1: A patient is seen in the ED with complaint of a rapid heartbeat. A 12-lead ECG is performed. In this case, the appropriate code(s) from the following code ranges can be reported:
99281-99285 (Emergency Department Services) with a modifier - 25
93005 (Twelve lead ECG)

Example #2: A patient is seen in the ED after a fall. Lacerations sustained from the fall are repaired and radiological x-rays are performed.
In this case, the appropriate code(s) from the following code ranges can be reported:
99281-99285 (Emergency Department Services) with a modifier - 25
12001-13160 (Repair/Closure of the Laceration)
70010-79900 (Radiological X-ray)

Example #3: A patient is seen in the ED after a fall, complaining of shoulder pain. Radiological x-rays are performed. In this case, the appropriate code(s) from the following code ranges can be reported:
99281-99285 (Emergency Department Services) with a modifier - 25
70010-79900 (Radiological X-ray)
NOTE: Using example #3 above, if a subsequent ED visit is made on the same date, but no further procedures are performed, appending modifier - 25 to 3

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