Primary Care Coding Alert

Question: An established patient came to our office because of knee pain. Our physician x-rayed the knee during the visit. Should we attach modifier 25 to the E/M code?Kansas SubscriberAnswer: No, you don't need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) in this situation.Here's why: You're billing for an x-ray and office visit. Like E/M services, x-ray services have an "XXX" global period, meaning the global period concept does not apply, so there is no evaluation or management presumed to be part of the x-ray service. Thus, there is no need to identify the E/M service as "significant and separately identifiable."If your physician administered a knee injection during the visit to help alleviate the patient's pain, then appending modifier 25 to the E/M service would be more appropriate. As a therapeutic, "000" [...]