Pulmonology Coding Alert

Question: When can I use modifier -25 for coding allergy immunotherapy?

Wisconsin Subscriber  
Answer: If the pulmonologist evaluates a patient and decides to provide allergy immunotherapy (95004) or immunotesting, 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 the E/M service.
 
Modifier -25 is used any time the physician performs an E/M service and another procedure on the same day because the payer wants to be sure a patient sent for a procedure is not having a history and physical performed that were not requested. It indicates that the physician performed the history and physical, not that the patient was sent specifically for a procedure. You must have an ICD-9 code that justifies the procedure. The diagnosis could come from the E/M procedure.
 
If an allergist sees the patient before the pulmonologist, you can bill the treatment with modifier -25, but only if the allergist and pulmonologist are in the same provider group and they bill at a group level. In this case, a physician would give a patient therapy after the patient has been tested.