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modifier 25

SuperCoder Posted Tue 12th of February, 2013 18:08:34 PM

can someone please clarify when you can use the "25" modifier. I know it protects your E & M code. if my patient has only one diagnosis, but receives 1 or more injections, can I use the modifier so that I will get paid for the E&M and the admin of the inj?

SuperCoder Answered Wed 13th of February, 2013 14:41:13 PM

Yes, if the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. To report this situation you would append modifier 25 to the E/M service for that day. Tip: Documentation should be separated from the documentation of the procedure.

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