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CPC

SuperCoder Posted Wed 15th of October, 2014 13:19:55 PM

When coding 99212 with 93281, would you just use modifier 25 on the 99212 or would you also use mod 26?

SuperCoder Answered Wed 15th of October, 2014 15:53:44 PM

Thanks for your question. You would not use a modifier 26 on any E/M code. Modifier 26 is only used for services that have both a technical and professional component; an x-ray for example. An E/M code does not meet the requirements for a code with technical and professional components. Modifier 25 would be the proper modifier to append to the 99212 in this case; however, there are certain requirements that must be met to use a modifier 25. You must be sure that the E/M visit is a significant, separately identifiable service and your documentation should be able to support this. Please see the link below for the additional requirements for modifier 25 use. Hope this helps.

https://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/checklist-eases-modifier-25-claims-33285-article

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