Pediatric Coding Alert

And sort out these scenarios to add to your understanding.

You’ve used modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) on so many claims you can’t even count.

But are you sure you’re using it correctly? If you’re not, or if you want reassurance that you are, maybe now is a good time to take our modifier 25 quiz. See if you can correctly answer the following two questions about modifier use, then apply your answers to the two scenarios to see if you’re a modifier 25 master.

Question 1:
What are the functions of a modifier?

Question 2:
What are the three functions of modifier 25?

Question 3:
Can you use modifier 25 in the following scenario? Your provider performs 11401 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm) on a patient’s leg lesion. No other service is performed during the encounter.

Question 4:
Can you use modifier 25 in the following scenario? An established patient falls from her bike just before arriving at your office and presents with a 2 cm laceration to the forehead. After reviewing her vaccination record to make sure her tetanus shot is up to date, your provider checks the patient for headaches and nausea, palpitates and inspects the area around the laceration for any other deformity and, in the absence of any other problems, performs 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less). Your provider then instructs the patient to keep the bandage clean and dry and return in 10 days.

Think you know the answers?