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Using modifier -25 for ADD and co-pays

Patti Posted Sat 01st of December, 2012 01:08:38 AM

We have many patients with ADD or ADHD. We do yearly exams on these children. The codes we use are for well visits and we a code for alteration of behavior if the prob-lem is between well periodic visits. We have a flow chart for medications given by the physician on a monthly basis.
• On the yearly well visit should we use a -25 modifier for ADD?
• When the parents pick up the monthly Rx should we charge a co-pay?
• In our community a visit to the psychiatrist for the medication generates a co-pay.
What are the codes we should use for billing?

SuperCoder Answered Mon 03rd of December, 2012 17:37:49 PM


We are working on this. Will post the answer soon.


SuperCoder Answered Wed 12th of December, 2012 18:48:31 PM

Hi there! If you bill a well visit along with a problem-focused visit, you should add modifier 25 to one of the E/M codes - typically to the sick visit code, but some insurers (particularly certain Medicaid carriers) want modifier 25 on the well visit code instead, so check with your insurer's preferences before billing.

If the parent just shows up for the medication refill prescription, you should not charge a copay since no face-to-face service between the patient and provider took place.

I'm unclear about your third question. Do you want to know how to bill when you refer a patient to a psychiatrist, or are you the psychiatrist?

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