# Spirometry with E&M same day



## sherring1 (Jul 2, 2014)

I would like some input on using modifier 25 with an E&M code on the same day as spirometry.  My physicians are pulmonary specialists.  I know that there is an NCCI edit associated with this, but I would like opinions, please, on these scenarios and whether you feel that a 25 modifier is justified:
1)Patient presents with cough and history of COPD.  Physician documents history, exam, and mdm; orders and interprets spirogram, orders and interprets 2 view chest x-ray, reviews records from family physician.  prescribes inhaler and orders full outpatient pft's.
2) Patient presents with cough, history of COPD, history of tobacco abuse, and abnormal chest x-ray showing a lung mass.  Physician documents level 4 history, exam, and mdm, orders and interprets spirogram, reviews actual x-ray films, reviews old records.  prescribes inhaler, orders CT scan of the chest, and schedules the patient for a bronchoscopy with biopsy.
3)Patient presents with dyspnea, wheezing, congestion, and complaints of excessive daytime sleepiness with snoring and witnessed apneas.  Physician documents history, exam, and MDM.  Physician orders and interprets spirogram, orders and interprets chest x-ray.  prescribes inhaler, nasal spray,  and orders outpatient 2 night sleep study for suspected sleep apnea.

Am I on the right track in thinking that all of the above represent work that is 'above and beyond' the usual pre-and post procedure work of the spirogram and warrants the addition of modifier 25 to the E&M code?


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## jwd59 (Jul 2, 2014)

*spirometry and modifier 25*

I work for an Internal Medicine doctor.  Many of our patients are elderly and have COPD/Asthma. We perform spirometry in our office.  You must add a modifier 25 to the E&M code to get paid.


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## sherring1 (Jul 3, 2014)

Yes, 25 modifier is a must to get paid.  The confusing thing is the MLN Matters article posted by CMS (SE1315) that says we should not be billing E&M if it is 'related' to spirometry on the same day.  Some part of the E&M is related, but other parts are not.  I don't want to improperly add a 25 and get my docs in trouble.  I just wondered if anyone else thinks the examples given are acceptable for using a 25.  Thanks for your reply.


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## mlbaker1974 (Jul 6, 2014)

*spirometry with E/M*

use modifier 25 on the E/M, if it gets pulled for an audit make sure to send the spirometry report with the E/M documentation.


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## sathyaraj (Jul 7, 2014)

hello,

25 modififier is usually use to indicate there is significant procedure(10 or 0 days global period) is done on same day with E/M,here there are some possibilities to indicate the significance,
1.the patient is came for cough,if the physician done any work up related to this cough no need to add any modifier code alone the E/M(problem oriented visit),here spirometry is done to identify the extend/seviority of the COPD this is not the problem oriented visit,the physician done the extended exam and additional work up done to evaluate the present problem, usually assign 25 modifier to the E/M.
2nd and 3rd scenario also the same only.

I hope this will help so,

Sathyaraj B.Pharm CPC,CEMC
Medical auditor BCBS


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## beulastella (Jul 7, 2014)

yes, Agree and need a clarification" in our case a patient came with the problem *asthma*, heretoo they did a comprehensive examination and ordered and done Spirometry. and they described the severity as Normal. Slight decrease in FEV1/FVC. "
 Do we need to append 25 modifier with this E&M?

Kindly suggest
S.Beula

Thanks


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## sathyaraj (Jul 7, 2014)

what is the need to do spirometry?
He have some suggestion to do spirometry to want to know the seviority of asthma.anyhow the service is done by the physician it should be paid based on the significancy of the E/M.for example if any lab test done to know the presence of bacteria,if it is absent/present we are coding the service to get paid. likewise, we should append 25 modifier eventhough if it is normal.


I hope this will help so,

Sathyaraj B.Pharm CPC,CEMC
Medical auditor BCBS


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## beulastella (Jul 8, 2014)

Thank you


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