# Consult with procedure (Help)



## broundy (Mar 30, 2010)

I have a provider that states that at her last practice they charged her consult fee and EMG without using a modifier.  I thought you had to add the 25 and that actually the fee was reduced.  Please give me your experiences or thoughts.  Thanks!!

Bonnie


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## m.j.kummer (Mar 30, 2010)

*To broundy-Consult with procedure (Help)*

Technically a consultation should not require a modifier simply because of the nature of the service.  In reality, there are several payers that do require it to be appended to the E&M code when it is reported on the same date as a procedure/diagnostic test, etc.

I would be more concerned that the E&M service actually meets the criteria to be reported with a consultation code.

For example, a family medicine provider requests a diagnostic test from a specialist via an order for an EMG study and instead the specialist bills a consult in addition to the diagnostic test. In this scenario there is no request for a consultation so it would be wrong to report a consultation.  Part of the EMG service is to issue a report which contains the findings and recommendations.  A consult is designed to provide similar information.  For this reason it seems unacceptable to bill for an EMG and a consultation the same evaluation.  Of course there are always exceptions and based on what information you provided, my educated “opinion”   is that the provider should not report a consultation and an EMG at the same time.  I am pasting the link to an interesting article regarding EMG documentation and reporting.  I hope it is helpful.


http://www.aanem.org/PracticeIssues/PositionStatements/documents/RptResultsEMGNCS.pdf


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## broundy (Apr 1, 2010)

*Consult and procedure*

Thank you for your reply.  I do understand what you are saying and I did not explain this very well I am afraid.  She does meet the criteria for the consult and decides many times at the consult that testing is needed, so she does it on the same day.  Am I wrong in thinking that when you add a 25 modifier the payment is reduced?  I am not sure where I got this information but it is stuck in my head   Thanks again for any help!  Bonnie


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## FTessaBartels (Apr 1, 2010)

*25 does NOT reduce payment*

The -25 modifier does not reduce payment. In fact, it allows for payment for the "Significant, separately identifiable" E/M service on the same date as a minor procedure.

F Tessa Bartels, CPC, CEMC


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## 1071471 (Apr 2, 2010)

I agree that modifier 25 does not reduce payment, it's quite the opposite. Maybe you were confused with the 52 modifier? 

Happens to the best of us !!!


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