# I work for an internist



## jnieto625 (Oct 20, 2008)

Can someone please help with modifiers.  I work for an internist who will see a patient, perform an ekg, administer a flu shot, and do some labs such as 81003 in the office all in the same visit.  I know that I am supposed to use a modifier 25 for the e&m code and I have properly linked the icd9's to the cpts.  Am I supposed to be using modifier 59 as well?


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## cdcpc (Oct 20, 2008)

Depending on your carrier rules, I would use a 25 modifier on the office visit when an injection is done at the same visit as an E/M.
I don't think you'd need to use a 59 modifier because "modifier 59 is used to identify procedures or cervices other than E/M services, that are not normally reported together..."  (CPT professional edition) 
Labs and EKGs are often times done with an E/M, so there isn't a need for a 59 modifier.
This is just my two cents


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## galebrow (Oct 20, 2008)

no modifier for flu vac /lab/ekg /e&m. When you get beyond these things, you need to look at modifiers/
if you did other procedure like ear lavage, you need modifier 25 on the E&M only. No modifer for E&M with EKG, routine lab testing, administration injection, etc.
59 added to the second + procedures, lets the carrier know that you have provided separate procedures = more than one on the same day. The first procedure does not have the modifier.


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