# PT/INR and E/M with modifier 25 in Long term care



## jbrannon109 (Feb 4, 2016)

It has been my understanding that billing an PT (85610) is only for the PT itself and not for the adjustment of the dosage of the medication. Since I work in long term care I have the question on if a low level E/M visit (99307) can be billed with a 25 modifier with a (85610) if an adjustment occurs. However, with the 25 modifier I am hesitant to proceed as the 99307 doesn't really stand alone without the 85610. Could anyone please shed some light on this scenario for me? I appreciate all your cooperation. I've been billing a while now and for some reason I keep asking this same question over and over and would really like to be compliant. Any Medicare guideline or helpful tips for Medicare I would also appreciate. I already receive the email listings but when I go out to the CMS website I get lost....to this day.
Thank you in advance,
Jen


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## thomas7331 (Feb 5, 2016)

You're correct in that the 85610 is for the test only.  Labs don't have an E&M component, so any evaluation and management of the patient, including adjustment of the dosage, would be a component of an E&M code, if the documentation requirements are met (modifier 25 is not required for most payers because the E&M should not bundle to a lab charge).  In a facility location though, you cannot bill physician services under 'incident to' rules as you could for a nurse visit in the office, so a dosage adjustment alone would not qualify for an E&M charge - the provider would need to see the patient and there would have to be documentation of a face-to-face encounter with the required elements in order to bill an E&M code.


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