Wiki 99214 and 69220. Mod 25?

[semmett]

If patient arrives to discuss results of hearing test and to have a surgical cleansing of the mastoid, can an E/M 99214 be billed with the surgery with a modifier 25?

Can a mod 25 always be added to the E/M when some other procedure is billed? I thought the 25 on an E/M code was only if it was completely unrelated to the reason for the visit.

Some like to add the 25 to an E/M every single time, which I don't think is correct and I want to be correct. Clarification please?

 

[jackjones62]

Your definition of Mod. 25 is off, it never mentions "unrelated", it states "significant, separetly identifiable E&M by the same MD on the same day of the procedure or other service". Re-read the definition and guideline for this modifier.

As long as your physician's notes support a 99214 level of service and they documented the "surgical cleansing of mastoid" such as an operative note, then you should have no issue billing 99214-25 and 69220.

Hope this helps.

Jennifer
CT ENT