# Modifier 25 with X-Rays?



## halebill (Feb 3, 2015)

Hello everyone!

I have an outside coding vendor telling me that some changes went into effect on January 1st in which the status indicator of many x-ray codes have changed, which now require the appending of modifier 25 to the e/m charge reported with those codes. The only literature I have seen deals with ultrasound guidance with joint injections and oncology radiation. We are an outpatient practice and routinely perform typical x-rays of extremities, chest, shoulders, etc. These services are not a procedure with a global surgical package. I can't imagine appending a modifier 25 to an e/m with an x-ray. Please chime in if you know anything about this. Thanks.


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## chelle511 (Feb 3, 2015)

Hi Bill... I am researching the same thing today on my coding contract.. my client is stating the same thing.. that Jan 1st.. all xrays were changed to status indicator S.  I put a standard chest x-ray into the encoder and it is coming up status indicator S.     Somehow I missed this change.   It is looking like modifier 25 will be needed to be added to all cases where x-rays are charged in the ED.  I am still researching and would also appreciate others chiming in..


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## mitchellde (Feb 3, 2015)

halebill said:


> Hello everyone!
> 
> I have an outside coding vendor telling me that some changes went into effect on January 1st in which the status indicator of many x-ray codes have changed, which now require the appending of modifier 25 to the e/m charge reported with those codes. The only literature I have seen deals with ultrasound guidance with joint injections and oncology radiation. We are an outpatient practice and routinely perform typical x-rays of extremities, chest, shoulders, etc. These services are not a procedure with a global surgical package. I can't imagine appending a modifier 25 to an e/m with an x-ray. Please chime in if you know anything about this. Thanks.



I have not looked but CMS puts out a transmittal every quarter with updates to the OCE and OPPS.  This would be the best resource to see if the status indicator has been changed from a T to an S.


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## cdr4life (Feb 3, 2015)

*xrays*

Hello, I have my CPC, and am actively coding for 4 clinics (not by myself, thankfully) and we have to add modifier 25 to the E/M when a patient has xrays done. It's always been that way with all insurance companies so they can pay correctly. Is there something I am missing??

Thank you, 

Stephanie Garrison, CPC
Medical Biller and Coder
Good Health Financial, PC 
4600 S. Mill Avenue, Ste 280 
Tempe, AZ 85282-6850
Ph: (480) 305-2888 Ext 1131
Fax: (480) 305-2889
sgarrison@goodhealthfinancial.com


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## mitchellde (Feb 3, 2015)

smoogie87 said:


> Hello, I have my CPC, and am actively coding for 4 clinics (not by myself, thankfully) and we have to add modifier 25 to the E/M when a patient has xrays done. It's always been that way with all insurance companies so they can pay correctly. Is there something I am missing??
> 
> Thank you,
> 
> ...


Outpatient facility is different than physician clinic.


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## chelle511 (Feb 3, 2015)

What I found from 2009 that explains why we append modifier 25 to E/M when we have coded a S and T type procedure  OR  an MRI or CT scan...   is because the MRI and the CT scan are Q2 or Q3 status procedures.

For OPPS services coded this year, coders must append modifier -25 to the facility E/M code whenever a procedure or service with an S, T, Q2, or Q3 status indicator is also billed for the encounter. And many radiology procedures that previously had an S or T status indicator now have a Q1, Q2, or Q3 status indicator. For example, x-rays with contrast, CT scans, and MRIs changed to a Q2 or Q3 status indicator. CT scans with and without contrast are now status indicator Q3, thus requiring modifier -25 be appended to the visit level.



The issue I now have in reviewing the status changes of the radiology procedure codes is that not all have changed to status S.  Many are Q1 status and based on previous guidelines would not require us to add 25 modifier to the E/M code.

Unless you have an encoder such as 3MHDM which shows you charges along with status indicators and edits....  you will have to review all radiology charges to and see if any have Q2 or Q3 or S status.... We know MRI and US... the only ones I see in the CMS list that have changed to S status are ones with fluoro... and a few other misc... 

Am I in the right track...?


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## mitchellde (Feb 3, 2015)

Yes you are!  MRI and CT scans were always status S procedures along with ultrasounds.  But ones like chest X-rays were always status T.  The federal register addendum B has alway provided a complete list of the status indicators, I wonder if it will show the Q status now.


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## Ponygirl60 (May 27, 2015)

Yes, believe it or not there are some x-rays that now have a T or S status indicator. Status indicators changed for 2015. For instance, in 2014 93005, EKG, had a SI of T. this year it has a SI of N or Q1 depending upon what it is billed with. The new changes are a bit daunting. You can go the CMS site and download an Addendum B for the SI of the codes, but know that depending upon what it is charged with,a SI can change. 71010 and 71020 when charged with an E/M level charge will now need a modifier 25. 93005 will not.


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