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Modifer 25-----CB

Lina Posted Tue 01st of September, 2015 13:35:03 PM

I would like some clarity on modifier 25. I know the definition of the modifier says a separate identifiable procedure. My question is for example we see a patient for sinusitis and that is the only diagnosis for the patient and they receive an injection during their visit for sinusitis can I bill the E/M code with a 25 modifier and also will the administration code of 96372 for the injection and be paid for both. If we do not use the modifier on the E/M code they will not pay for both

SuperCoder Answered Wed 02nd of September, 2015 00:45:41 AM

No, if patient came with only 1 problem, i.e. Sinusitis, than you cannot bill E/M service with -25 modifier. You need to bill only for Injection, 96372.

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