Wiki Modifier 24 vs 25

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echupa72

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I am billing 99223 and 99406 with a 25 modifier. Per insurance company, they are rejecting for incorrect modifier. My employer is looking into utilizing a system to obtain correct coding. This website advises the use of modifier 24 with these E&M codes. This doesn't sound correct to me. Can you please offer some advice?
Thank you.
 
mod 24 is to be appended when the pt is in a global period and is seen for follow up for something not related to the reason that they had the procedure for. Modifier 25 is appended when the pt is seen for an office visit and a procedure is done the same day. There must be a separately identifiable documentation in the chart to support the ov e/m code. Your 99406 is for tobacco counseling and you would not need a modifier on the 99233 code since 99406 is not a "procedure". Many payors do not pay for the counseling separately, they will only pay for the E/M code.
 
CCI edits show that 99406 is a component of 99223 (which is a column 1 code). This generally tells you that the modifier is needed on the column 2 code, which in this case is 99406. So if I was basing this off of the CCI edits, I would add a modifier 25 to the 99406 and have no modifier on the 99223 (unless another is appropriate based on documentation/globals/etc).

Modifer 24 definately would not be used since there is no applicable global period related to this specific combination.

However, you may want to check with you payor to see if they even require a modifier at all.
 
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