# Modifier 25 - My office mate and I have a question



## becca12

Hello,

My office mate and I have a question about modifer 25 on immunizations.  I looked on couple websites about if you need to add a modifer on the office visit if they come in for the flu vaccine and an office visit.  They are saying that the adminstration and the vaccine don't bundle into the office visit.  My office mate said that I should add the modifer 25 to the office visit.  So my question is do I need to add a modifer 25 to the office visit or not?

Thank you in advance,
Rebecca


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## drampas3418

That depends, if the only reason the patient was seen on that day was to received immunizations then you cannot bill an o/v at all. If however the pt was seen for a cough or a cold or any other reason, you can then bill for the o/v adding the modifier 25 and you will be paid for the o/v and the immunizations


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## kumeena

In my office I was told  that"vaccinations are given by nurse so don't use modifier 25"


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## jsa1517

becca12 said:


> Hello,
> 
> My office mate and I have a question about modifer 25 on immunizations.  I looked on couple websites about if you need to add a modifer on the office visit if they come in for the flu vaccine and an office visit.  They are saying that the adminstration and the vaccine don't bundle into the office visit.  My office mate said that I should add the modifer 25 to the office visit.  So my question is do I need to add a modifer 25 to the office visit or not?
> 
> Thank you in advance,
> Rebecca


In my office, for a flu shot, we bill the vaccine & administration and a minimal office visit & add modifier 25 to the office visit. The patient is only coming in for the flu shot, however sometimes 1 additional dx is added to help get the office visit paid.


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## FTessaBartels

*Do NOT code to get paid*

jsa1517 writes: The patient is only coming in for the flu shot, however sometimes 1 additional dx is added to help get the office visit paid.

Please do not code something "just to get paid."  If the reason for the visit is to receive the injection then NO E/M service is billable.  

drampas3418 said it perfectly. If there is a genuine sick visit, plus you are giving the injection then you use the -25 modifier on the E/M service to show that it is a "significant, separately identifiable" service. 

F Tessa Bartels, CPC, CEMC


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## jsa1517

FTessaBartels said:


> jsa1517 writes: The patient is only coming in for the flu shot, however sometimes 1 additional dx is added to help get the office visit paid.
> 
> Please do not code something "just to get paid."  If the reason for the visit is to receive the injection then NO E/M service is billable.
> 
> drampas3418 said it perfectly. If there is a genuine sick visit, plus you are giving the injection then you use the -25 modifier on the E/M service to show that it is a "significant, separately identifiable" service.
> 
> F Tessa Bartels, CPC, CEMC


I didn't mean it as "just to get paid", I guess I should have gone into more detail...I meant it as when the patient is coming in requesting the flu shot and during this a cough, cold, sore throat etc.. are mentioned/discussed, this time ends up allowing us to be able to bill a visit, and there is additional diagnosis, we use the modifier -25 for the visit to distinguish the "significant, separately identifiable" service. Which in this case we only bill a minimal visit. Just as drampas3418 said it "If however the pt was seen for a cough or a cold or any other reason, you can then bill for the o/v adding the modifier 25 and you will be paid for the o/v and the immunizations".

I guess I should have gone more into detail. Sorry about that! We don't just code something to get paid.


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## dk

*physician assistant with a 25*

If a patient is in the ER and they are only managed by a PA, can the modifier 25 be assigned - just as if it were a physician?  Considering all conditions are met to assign the modifier??


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## SherryMoss

Here in FL, even with a -25, we don't get paid for a 99211.  99212 with a -25 (assuming separate reason for the E&M - not related to the vaccine) does get paid.


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## LTibbetts

dk said:


> If a patient is in the ER and they are only managed by a PA, can the modifier 25 be assigned - just as if it were a physician?  Considering all conditions are met to assign the modifier??



Yes, you can. All records of patients seen by PA's are eventually signed off by an attending doc so you can use the modifiers, assuming that all requirements are met.


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## codeforever

*Requirements of co-signatures on ER's by dr?*

Is there a written requirement for ER records to be co-signed by the Dr when an ARNP, or PA completes the ER record?  Does anyone have the direct info on that? Please and thank you.


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