Wiki Modifier -25 billed with G Code

[tierneyshob]

Is it appropriate append Modifier 25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to G0442 (screening for Alcoholism)? The Modifier 25 is being used because G0442 is being billed with the office visit code 99213.

My understanding is that Modifier 25 is only appropriate to append to Evaluation and Management (E&M) Codes like 99213.

A colleague of mine proposes that since G0442 is like a E&M code then the Modifier -25 would be okay. However in my opinion G0442 does not have all the elements of an E&M code, so Modifier -25 would not be appropriate, Modifier -59 should be used instead. Thanks!

 

[lmartien]

I agree with you. I would append the -25 modifier to the 99213, citing exactly the reason you give, E&M services only. Although the G code is "like" an E&M code, it's being billed with another E&M code so I would go with the more exact directive from CPT guidelines.

Linda Martien, CPC, CPC-H CPMA