Wiki 25 modifier - medical issues and is billing

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jackiems

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If the patient is being seen for a preventive visit (99396) but the physician also addresses medical issues and is billing for an ov e/m (99213) and performs a cerumen removal (69210), would a 25 modifier go on both the e/m and preventive or just the ov e/m? We dont run into this very often but I had put the 25 on the 99213 but Cigna denied saying it was bundled into the 99396. It seems like overuse of the 25 modifier if I were to put it on the 99396 too.
 
When billing preventive services with a problem-oriented E&M you must put the -25 modifier on the problem-oriented E&M (99213) to keep it from bundling into the preventive code. However, we have recently seen insurance carriers deny the preventive service as bundled into any minor procedures or injection codes now as well. So in that case, I would recommend applying -25 to both preventive and problem-oriented E&M to make the statement these are significantly separate from anything else billed at the same time. I have seen some coders recommend applying the -59 to the minor procedure to indicate the procedure (injection or minor procedure) is separate.

So I think you need to try the first method. If that doesn't work, then try the second method until you figure out how the particular payor accepts it. It is funny how it is always in the insurance carrier's favor.

Also make sure the diagnoses are linked correctly to each service.
 
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