Wiki Justify 25 modifier

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Lynda Wetter

Lynda Wetter

True Blue
Local Chapter Officer
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Glen Allen, VA
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Patient comes to office for a lump which is evaluated and drained 10060= 10 day global. 25 mod?
Also requested STD screening and other fasting labs 36415= if patient present with no symptoms for screenings labs only= no charge visit.
Also receives Flu vaccine. 90471 = 25 modifier?

If we bill an office visit it will bundle at least with the 10060 or the 90471. If I add a 25 what dx what i use? The elements that i have on the report can be leveled to a 99213 using the complaint of the abscess that gets drained. So that right there does not justify the 25 being significantly separate from the drainage its kind of part of it!
Charging a visit for the labs would be a 99211 which we all know bundles and you cannot charge for.

I feel like we do not have a visit charge here.

opinions?
 
Modifier 25 can ONLY go E/M codes not surgery codes or administration codes. Who seen the patient? Did the office note talk about everything, I need more information. If there was an office visit with a procedure, flu shot and something else and the office note supports this, then do the appropriate E/M level and put the mod 25 on the E/M
 
i agree. if you have a dx for an E/m, then apply the 25 modifier. then your drainage and then your flu and admin. did the patient state that he/she were exposed to STD?
 
krisw7067 said:
Modifier 25 can ONLY go E/M codes not surgery codes or administration codes. Who seen the patient? Did the office note talk about everything, I need more information. If there was an office visit with a procedure, flu shot and something else and the office note supports this, then do the appropriate E/M level and put the mod 25 on the E/M
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I know 25 is for e/m only. They talked about the abscess, patient requested flu vaccine, std labs and other fasting labs. Nothing else was discussed. The appropriate documentation was there for the procedure (informed consent etc. ) problem pertinent exam for the abscess. I am thinking there's no way to separate anything out to justify using 25 on an e/m.
 
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