MrsJones80
New
Hi all, I am just starting out on my 1st job as a coder and it is an outpatient clinic that specializes in wound care. We are connected to a hospital for which we bill facility services and I am the professional services coder/biller. Lately, I have begun to question myself on the topic of modifier 25 applications due to some debate between myself and the various providers. If you all don't mind helping out, I'd really appreciate it! Thank you!
My first question is, if a provider sees a patient for a follow up appointment and the patient has a new wound, but performs a debridement on the existing wound, is modifier 25 appropriate?
I say yes, new wound equals new problem
2. If a provider sees a patient for a follow up appointment and the wound has become infected and antibiotics are prescribed, is modifier 25 appropriate?
I say if a procedure is performed on the same wound, then no, but it a procedure is performed on a different wound, then maybe
3. If a provider sees an inpatient at a hospital for the professional service component and they are a new patient to that provider/group, is modifier 25 appropriate if they determine to perform a debridement?
I have read that because they are not the admitting physician they cannot bill an E/M even if the patient is new to them.
4. If a provider sees a Nursing Home patient for the professional services component and they are a new patient to that provider/group, is modifier 25 appropriate if they determine to perform a debridement?
I have read that because they are not the admitting physician they cannot bill an E/M even if the patient is new to them.
5. If a provider sees a patient for a follow up appointment and makes a referral to another physician and/ or clinic, is modifier 25 appropriate?
In my opinion, if the visit is a straight E/M visit then the level of MDM does increase somewhat, but if a procedure is performed, then no
6. If a provider sees a patient for a follow up appointment and orders an imaging test (CT, Xray, MRI) or vascular testing, to determine osteomyelitis or because a wound is stagnant, is modifier 25 appropriate?
I think that if it is for a separate wound from the one that has a procedure, maybe
7. Where am I right and where am I wrong?
My first question is, if a provider sees a patient for a follow up appointment and the patient has a new wound, but performs a debridement on the existing wound, is modifier 25 appropriate?
I say yes, new wound equals new problem
2. If a provider sees a patient for a follow up appointment and the wound has become infected and antibiotics are prescribed, is modifier 25 appropriate?
I say if a procedure is performed on the same wound, then no, but it a procedure is performed on a different wound, then maybe
3. If a provider sees an inpatient at a hospital for the professional service component and they are a new patient to that provider/group, is modifier 25 appropriate if they determine to perform a debridement?
I have read that because they are not the admitting physician they cannot bill an E/M even if the patient is new to them.
4. If a provider sees a Nursing Home patient for the professional services component and they are a new patient to that provider/group, is modifier 25 appropriate if they determine to perform a debridement?
I have read that because they are not the admitting physician they cannot bill an E/M even if the patient is new to them.
5. If a provider sees a patient for a follow up appointment and makes a referral to another physician and/ or clinic, is modifier 25 appropriate?
In my opinion, if the visit is a straight E/M visit then the level of MDM does increase somewhat, but if a procedure is performed, then no
6. If a provider sees a patient for a follow up appointment and orders an imaging test (CT, Xray, MRI) or vascular testing, to determine osteomyelitis or because a wound is stagnant, is modifier 25 appropriate?
I think that if it is for a separate wound from the one that has a procedure, maybe
7. Where am I right and where am I wrong?
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