# E/M and x-rays



## lkramer13

Do I use a 25 modifier for the E/M code when an x-ray is done the same day in the office.  Thanks for your help guys!!


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## Manasa Reddy Salipela

*No modifier when any diagnostic radiology is done along with E/M*

In office visit modifier 25 cannot be given to E/M if an x-ray is done; as physician himself will not be taking the xray instead he interprets the xray taken hence 26 modifier can be appended to xray but not modifier 25 to E/M.


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## thomas7331

Actually I believe the information in the post above is incorrect.  The NCCI table does pair E/M codes with some x-rays and in those cases a 25 modifier will be necessary to indicate that the E/M visit was comprised of services separately identifiable from those associated with the x-ray itself.


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## ladymatthew

I work in orthopedics and code for a clinic of surgeons and have NEVER added modifier 25 to an E/M level when xrays are performed same day in office.  I haven't ever had issues with reimbursement either.  Best of luck to you!


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## sweller

A 25 modifier is not necessary when billed with an Xray(s). Also, see modifiers TC, as well as 26, to append to the Xray. The Xray will require a TC, 26, or neither (neither for global billing of the Xray). Good Luck to you.


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## thomas7331

Whether or not the modifier is needed to avoid denials may all depend on your payers and their guidelines.  The practices I code for are facility-based and our Medicare carrier does edit/deny for E&M charges billed together with X-rays on the facility claims if no modifier 25 is billed.  

Either way, the following instructions from CMS in the radiology section of the NCCI manual include this guidance on the use of the modifier 25:

_"Procedures with a global surgery indicator of “XXX” are not covered by these rules. Many of these “XXX” procedures are performed by physicians and have inherent pre-procedure, intra-procedure, and post-procedure work usually performed each time the procedure is completed. This work should never be reported as a separate E&M code....With most “XXX” procedures, the physician may, however, perform a significant and separately identifiable E&M service on the same date of service which may be reported by appending modifier 25 to the E&M code. This E&M service may be related to the same diagnosis necessitating performance of the “XXX” procedure but cannot include any work inherent in the “XXX” procedure, supervision of others performing the “XXX” procedure, or time for interpreting the result of the “XXX” procedure. Appending modifier 25 to a significant, separately identifiable E&M service when performed on the same date of service as an “XXX” procedure is correct coding."_


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## bedforak1

No, a modifier 25 is not necessary.


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## rbandaru

Hello,

As per guideline coder will give 25 modifier for E/M code as X-ray is not done by physician.

Regards
Dr.Ramnath Bandaru, CCS, CPC
American Medical Services LLC
http://amshealth.com/
Twitter: @HospitalCoders


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## Nreed

I agree with Thomas7331 below and add the 25 modifier to the E/M as this is a separately identifiable service, but would also like to add this.

In order for you to be able to get separate payment for your X-rays, and not to bundle them in with your E/M visit code, there are certain things that are required and that is to have a separate x-ray report.  Now, whether you have it at the bottom of  your office notes, or in a completely separate report, here is what is required.  
1.	The number and type of Views taken 
2.	The anatomic location that you are x-raying
3.	A Diagnosis/reason for you taking the x-ray(s)
4.	Your interpretation of the x-rays (final impression)

Don't forget, when you are billing for x-rays in the office, you are billing also for an "interpretation".  

Both CPT rules and Medicare billing/payment rules address the need for a separate written report, and Medicare further states the report should mirror a report by a specialist in the field.  See CMS Chapter 13 Radiology services Rev 20.1 and 100.1, and also the ACR with the requirements of documentation for interpreting reports.  If you don't have this separate report, you cannot bill for the x-rays as they would be included in your E/M code.


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