Neurology & Pain Management Coding Alert

Question: If a patient comes to the office and has an evaluation and management (E/M) visit and an echo/Doppler study, should modifier -59 or -25 be used?

New Mexico Subscriber

Answer: Modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is the appropriate modifier to use. Modifier -59 (distinct procedural service) is used for procedures that would not normally be performed together. Modifier -25 should be used with the E/M code to indicate that a significant, separately identifiable E/M service was performed by the same physician on the same day as the procedure or other service.

Due to edits in the recently released CCI version 6.3, it is now mandatory to append modifier -25 when an E/M service is performed with any of the following tests in this category: 93875 (noninvasive physiologic studies of extracranial arteries, complete bilateral study [e.g., periorbital flow direction with arterial compression, ocular pneumoplethysmography, Doppler ultrasound spectral analysis]), 93880 (duplex scan of extracranial arteries; complete bilateral study), 93882 (duplex scan of extracranial arteries; unilateral or limited study), 93886 (transcranial Doppler study of the intracranial arteries; complete study) and 93888 (transcranial Doppler study of the intracranial arteries; limited study).

Additionally, the criteria for the use of modifier -25 must be met if the modifier is used.

Answered by Kathy Zmuda, CPC, lead inpatient coder, Cigna Health Care of Arizona, Phoenix.