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Urology Coding Alert

Reader Question:

Modifier -25

Published on Sat Jan 01, 2000

Question: I am having trouble getting a private carrier and an HMO to recognize modifier -25 for an office visit combined with uroflowmetry (51741). Appeals also have failed on several levels. Can you help?

Anonymous Ill. Subscriber

Answer: CPT is quite specific on this issue in the Evaluation and Management (E/M) Services Guidelines, which say: The actual performance and/or interpretation of diagnostic tests/studies ordered during a patient encounter are not included in the levels of E/M services. Physician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The E/M service may be caused or prompted by the symptoms or conditions for which the procedure and/or service was provided.

Your contract with the above-mentioned carriers should indicate if the carriers are going to reimburse for services provided using a reference other than CPT. A meeting with a carrier representative regarding their deviation from CPT seems in order.
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