Primary Care Coding Alert

Question: We-ve received letters from CMS regarding modifier 25. We use this modifier on the office E/M when the physician performs a visit and an EKG. Is this appropriate?

Arizona Subscriber

Answer: The answer depends. You should not use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on an E/M code (such as 99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient ...) when your physician performs an EKG, Protime, or any ultrasound study as part of a pre- or postprocedural workup.

Some carriers want you to append modifier 25 onto your E/M code (such as 99201-99215) when the FP performs an EKG (such as 93000, Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) in diagnostic cases.