# modifier 25 - checked the claim repeatedly



## Christi7 (Mar 15, 2011)

Hello Everyone!

I need your help!

I have been hitting the same cci edit for the last 3 days...... Can anyone tell me if there are new exceptions to the 25 modifier????

The edit I am hitting is telling me that I need a 25 modifier on a 
94660 ( vent ). I checked the claim repeatedly looking to see if the patient was seen in the ER, but was not.

PLEASE HELP????????


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## btadlock1 (Mar 15, 2011)

Christi7 said:


> Hello Everyone!
> 
> I need your help!
> 
> ...



25 modifiers only go on E/M services. You may have to have a 59 - so they weren't in critical care or under anethesia? I can't think of what would cause that...Have you checked the edit tables?


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## Christi7 (Mar 15, 2011)

Hi Brandi

I am aware that 25 goes on E&M, I have checked the cci edits on cms and I am coming up with nothing-

its driving me nuts?

the edit is reading : Warning: procedures or HCPCS in ranges, (has way to many to retype) 93005 and g0290 are what I'm hitting against- 
cannot not exist without a "25 modifier"

I'm thinking its a bad edit, but there are quite a few ranges:

example of ranges asking for 25 modifier included on edit:
90801-90802, 90804-90815,90845-90847, 90849,90853,90857,90862,90865,90880,90899,94002, 94003,94660,94662,94762,96101-96103,96110-96111,96116,96118-96120,96150,96151,96152-96154,99205,99215,99284,99285,99291,g0378,g0379,m0064

thanks for your help!
Christi


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## vinothbpt99 (Mar 16, 2011)

*Answer*



Christi7 said:


> Hello Everyone!
> 
> I need your help!
> 
> ...



answer to this,
 we know that 25modifier only for minor procedure along with E/M ie,significantly identifiable service by same physician and if it gets edit,we link 59 mod only not 25mod.please check cms website for cci edit because we know that it will update by cms in every 3months once.

Thank you 
vinoth.m


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## Christi7 (Mar 17, 2011)

Thank you for your help- But I did check the CMS website-

I did however get my answer, 

Medicare's January OPPS updates, thats were my answer was.

Like I said, there are SEVERAL stauts indicators Changed, So these codes ACT like E&M services and do require the 25 modifier-

Thanks for trying to help


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