Wiki 99214 - the senerio

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cingram

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ok im in a debate with someone. here is the senerio. 93000 was billed with a 99214 do you add a -25 to the e/m
 
I went over the guidelines, and I would append the 25 modifier. What is the debate?
 
well im volunteering at an office where my cousins mom is the office mananager and ma so she does the billing I took the cpc and that was a question on there and I have seen in a million times helping them with their billing and I chose the answer with the -25. she said that you dont add the 25 because its not a "procedure" but they add the 25 when they do acupuncture. I know im right I just wanted some other opinions. anyway in her office she bills 93000 with a 99214 with no modifer and it gets paid
 
hello, in our clinic we were told to append the modifier 25 when 93000 is done. it does get paid but of course the rule we're all familiar with..."depending on carrier rules"

hope this helps!
 
I did some more research and found that 99214 and 93000 are seperately billable. The one thing that was mentioned is if the patient comes in frequently with the same diagnosis having EKG's, you shouldn't append the 25 each time. But if they come in presenting with a new problem (new diagnosis) then you would append the 25. I have always questioned this myself and hopefully others will respond to this and give us both more advice.
 
I was also going to say that..."depending on carriers rules". And just because it was paid, does not mean it was correct. Carriers will pay with or without a 25 modifer. The 25 modifer just says whether it was a "siginficant, seperately identifiable eval....."
 
well the question was on the cpc it just said estab pt came in for ekg and the 2 answers I narrowed it down to were 93000, 99214 or 93000, 99214-25
 
I know for outpatient billing you do not add the 25 with an EKG since the EKG is a status X procedure and in outpatient you add the 25 modifier only when a status S or T procedure is present. Perhaps this is the way most payers view this for physician billing. I can see the follow up EKG needing the 25 much the same as a second joint injection cannot be billed with an E&M unless there is some other reason for the patient to be there.
 
Confussed

OKAY ,,
E/M 99214 AND 93000 ELECTROCARDIOGRAM WAS DONE.
I was told not to add the modifier 25

can some one give me some input.. please please:p
 
Last edited:
Look to your NCCI code pair edits. 93000 does not bundle to the office visit codes, therefore modifier 25 should not be reported on the E&M service. The example below is from Codify, but you will get the same result if you use another program for looking up NCCI edits (or if you still order the books each year.
 

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