Wiki 25 modifier

[Alisha Lemmons]

Hello,

Is the -25 modifier supposed to be added to E/M service when a diagnostic test is also administered. I do add it when an injection is also given with a E/M. For Tenncare we are adding a -25 modifier to our child wellness visits also. Thank you for any information.

 

[ljulien]

Mod-25 is typically not needed for an E/M and diagnostic tests. Do you have a payer requesting it be used?

 

[OCD_coder]

FYI: Medicare NCCI Policy Manual instructs coders to use a modifier 25 on the E&M when procedures with an XXX global status code procedures. This would include diagnostic testing, medicine codes, etc.

Even though, we don't think of labs/diagnostics as minor procedures, carriers may program their computers to want that modifier 25 to open the door and allow the claim to pass through the door.