Wiki Best modifer to use when Spirometry or EKG's are done during an office visit

[cwestman]

Admittedly I struggle with when to use modifer 25 verses 59
If a patient has COPD and the provider is looking to assess lung function during a routine follow up appointment
Or
If a patient c/o chest pain duuring a follow up appointment for his diabetes and HTN and the provider orders an ekg
If in both scenerios the providers staff performs the procedures the results are interpreted by the ordering provider and documentation supports same
I beleive a modifer 59 would be most appropriate ,however not completely sure.
I maybe overthinking this but is the use of either modifier determined by reason for the diagnostics whether it be done as an annual assessment(but not duing an annual exam) on the same day to save the patient another seperate visit or diagmostic to rule out a condition or a concern
If anyone can help clear the air I would appreciate your help I have researched abd looked at several examples but still find this confusing
Thank you
Cheri

 

[Pam Warren]

Per CCI, the spirometry and office visit can be billed together if you add the -25 to the office visit. The -25 tells the payer that the office visit is for something separate from what would normally be done to determine if a spirometry is appropriate. Make sure that's the case before you bill both. The EKG does not require a modifier when billed with an OV (per CCI), but sometimes commercial payers want to see the -25 to bypass claim edits. We get it in writing before we add the modifier, though.

If you bill all three together, you'd add the -25 to the OV, and the -59 to the EKG. The -59 is the modifier of last resort, so you use it only when no other modifier is appropriate. It's never appended to an office visit, and you still have to make sure that your documentation supports the use of the modifiers.

 

[cwestman]

Thank you,that really does help