# Modifier 25



## krssy70 (Nov 19, 2009)

I have a patient that underwent surgery months ago, and now has a wound seroma.  She continues to follow-up in the office every 2 weeks, (THE PLAN)with the physician for a wound-VAC closure.  My question is can we bill an office visit every time the patient comes back with a mod 25.  The physician has *this plan *for the patient, and the patient is only being seen for the wound-VAC closure.  However, the physician is dictating an HPI for the cancer diag, along with a Past HX, and Phy Exam, but is only treating the patient for the wound closure. Because he is doing an HPI, and Phy Exam, is the procedure considered separately identifiable??????


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## kbarron (Nov 19, 2009)

Are they in a 90 day global? If they are, it is part of the surgical package.


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## krssy70 (Nov 19, 2009)

The patients surgery was in January, so no global period pertains.


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## krssy70 (Nov 20, 2009)

Please help!!!! If anybody knows the answer to this question, I would greatly appreciate a response. This patient continues to come back to our office for this wound-VAC closure of this complicated wound... Please keep in mind, that this is a planned procedure, not within a global period, and the doctor dictates a HPI, PFSHx, and physical Exam on every visit due to the diagnosis of the patient, History of stage 1A, grade 1 endometrioid adenocarcinoma of the uterus. 

Please help!!!!! Do I bill the office visit with a mod 25 and the procedure 11040, or just the procedure?????


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## kbarron (Nov 20, 2009)

I would only code the procedure as that is the chief complaint.


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## kjstearns (Nov 20, 2009)

In this case, you should only be billing the procedure. An E/M is only billable if it is for a separate, unrelated problem.

Hope this helps!
Kirsten, CPC


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## Mjones7 (Nov 23, 2009)

Hi Kirsten, in this scenerio, I too would only code the procedure as you are not meeting the definition for use of the -25 mod with and E/M.


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