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USING MODIFIER 25 & 59

Robert Posted Wed 01st of May, 2013 21:58:57 PM

IN PEDIATRICS WE HAVE A NEW OCULAR VISION SCREENING MACHINE - FOR PREVENTIVE CODES '99393' FOR A 4 YR CK UP DX: V20.2 ALONG WITH '99174' FOR THE VISION SCREENING. WE HAVE BEEN TOLD TO USE A MODIFIER '25' ON THE '99393'. IF THIS CORRECT?

IF THE PATIENT COMES IN FOR A VISION PROBLEM AND WE CODE THE VISIT '99213' WITH THE MODIFIER '59' AND THE SCREENING CODE '99174' IS THIS CORRECT OR SHOULD WE USE MODIFIER '25'?

SuperCoder Answered Fri 03rd of May, 2013 10:58:45 AM

Hi,

We are working on this.Please be patient.

Thanks

SuperCoder Answered Wed 08th of May, 2013 00:18:53 AM

Hi there! There is no CCI edit precluding you from reporting either of the code pairs together (99174 and 99393 or 99213 and 99174). However, many payers will still want the modifier 25 appended to the E/M code (99393 or 99213) before they'll pay for both. For these payers, you'll use modifier 25 on the E/M code and not modifier 59. Thanks!

Torrey Kim, CPC
Editor, Pediatric Coding Alert

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