Pediatric Coding Alert

Question: Some coders suggest using modifier 25 on the well visit code when also coding 96110. Others recommend appending modifier 59 to 96110 while also coding for the well visit. Which is the proper way? Florida Subscriber Answer: Some private payers require modifier 59 (Distinct procedural service) on a procedure code to designate it as distinct from an E/M service. Therefore, you may have to report modifier 59 on the development screening (96110, Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) and no modifier on the preventive medicine service code (such as 99392, Periodic comprehensive preventive medicine reevaluation and management of an individual & early childhood [age 1 through 4 years]). Per CPT, however,the correct submission is to use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service) [...]