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Office visit and admin fee

Stephnaie Posted Mon 09th of June, 2014 17:19:12 PM

Patient is seen 99213. Immunization with admin 96372 is performed.
Do we apply modifer 25 to 99213?
Do we apply modifier 59 to 96372?

Thank you.

SuperCoder Answered Tue 10th of June, 2014 08:21:13 AM

Thank you for your question.

Modifier 25 would need to be applied to 99213 when the immunization administration code 96372 is coded as well. Modifier 59 would not be used in this case. See descriptions below (

When to use Modifier 25:

The E/M occurs on the same day as the surgical procedure
The procedure following the E/M is minor (has a zeroor 10-day global period)
The E/M service is both significant and separately identifiable from any inherent E/M component that the procedure involves
The same physician (or one with the same tax ID) provides the E/M service and the surgical procedure.

Modifier 59:
Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.

Stephnaie Posted Tue 10th of June, 2014 09:29:50 AM

Thank you so much.

SuperCoder Answered Tue 10th of June, 2014 12:05:07 PM

You are welcome

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