# 9939x & 96372



## arrana (Jan 14, 2013)

Can modifier 25 be attached to a wellness exam code such as 9939x when another procedure is done at the same time, for example but not limited to, a 96372 therapeutic injection?

In other words, is this valid coding:
9939x - 25
96372

Thanks,
Arrana
AR Representative
Outer Cape Health Services
Wellfleet, MA


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## kathyseyfried (Jan 14, 2013)

*Modifier -25*

Modifier -25 is never appended to preventive service codes.  It is only to be appended to the problem-oriented E & M code (office/OPD=99201-99215).  

Re: 96372 - this is an injection code and, usually, you bill the drug as well (HCPCS code).  Are you using 96372 for a vaccine administration?  If so, you are using the incorrect code - it should 9047x and the appropriate vaccine code.

You might ask the doctor, or review the documentation, for the reason the 96372 (non-vaccine injection) was given.  Was there a significant, separately identifiable problem oriented E& M service that day resulting in the need for the injection?


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## OCD_coder (Jan 15, 2013)

I must strongly disagree with that advice, a preventative service *IS *an E&M.  It's in the E&M section of the CPT book and in the preventative medicine family of codes and you will need a modifier 25 appended when ever you have a minor procedure with a global period of 0-10 days, such as the 96372 code on the same DOS as an E&M.

This the message that comes up in 3M and similarly in Optimum when you run a edit check:
"_A CPT procedure has been coded along with an E&M (evaluation and management) code. If this is a significant, separately identifiable E/M service by the same physician on the same day, then modifier -25 should be added to the E/M code_"


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