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Practice Management Alert

Reader Question:

Payer Rules Determine Modifier 25 Use

Published on Thu Jan 13, 2011

Question: A patient came in for an office visit with the complaint of shortness of breath (786.05), and after performing a pulmonary function test/spirometry (94375) and a chest x-ray, the physician determines the patient has COPD (496). When billing the office visit (99204) along with 94375, should I put modifier 25 on 99204 before billing? Oklahoma SubscriberAnswer: Whether you should append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99204 (Office or other outpatient visit for the evaluation and management of a new patient ...) when you bill the office visit with 94375 (Respiratory flow volume loop) will depend on the payer you are submitting the claim to and the policies that payer follows.Reasoning: Services in the Medicine section of the CPT® manual that have XXX global periods should not require modifier 25 on [...]
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