brittany_plambeck@hotmail.com
Contributor
Is it necessary to append modifier 25 onto the E/M if labs were drawn the same dos.
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Wiki Labs with modifier 25
- Thread starter brittany_plambeck@hotmail.com
- Start date
jbhuju
Guru
not for the labs as i know of 
brittany_plambeck@hotmail.com
Contributor
That's what I was thinking but just wanted to make sure! I appreciate your response! Thank you
Modifier 25 is only appended to an E/M visit. Not the other services that day.
brittany_plambeck@hotmail.com
Contributor
So say a patient came in for a follow up for hypertension and labs were drawn for the hypertension, would we need to attach modifier 25 onto the E/M visit?
Modifier 25 is used when there's a separately identifiable E/M service performed the same day as another service. The purpose is to stop the E/M code from being bundled into the procedure reimbursement.
For example, the patient comes in for hypertension and the doctor also removes a suspicious-looking lesion from the patient's skin for biopsy. The modifier 25 would go on the E/M visit so the provider could be paid for the work to evaluate hypertension. Otherwise, the provider would just get reimbursed for the in-office procedure (lesion removal).
TThivierge
True Blue
Hi
If the lab test is done 2 times (CPT 82043 as example)on the claim line I put modifier 91 for repeat lab test. Modifier 25 is only used for evaluation mgnt CPT codes.
I hope this information helped you
Lady T
If the lab test is done 2 times (CPT 82043 as example)on the claim line I put modifier 91 for repeat lab test. Modifier 25 is only used for evaluation mgnt CPT codes.
I hope this information helped you
Lady T
amyjph
True Blue
Are you talking about the venipuncture CPT 36415? I believe there is a P2P edit between 99211 & 36415, but that opens another can of worms on why you would be trying to bill 99211 with 36415.
There are also some cases where a payer might have a weird rule in their guidelines and wants a 25 modifier when not normally used. It's pretty rare though. Strictly talking about NCCI edits, I think 99211 is the only time.
www.novitas-solutions.com
You can always check the P2P edits for the CPT you are trying to bill with the E&M.
There are also some cases where a payer might have a weird rule in their guidelines and wants a 25 modifier when not normally used. It's pretty rare though. Strictly talking about NCCI edits, I think 99211 is the only time.
Modifier 25 fact sheet
www.novitas-solutions.com
You can always check the P2P edits for the CPT you are trying to bill with the E&M.