Wiki Modifier -25 - DMSO installation

[nateich]

Separate scenarios, thank you for taking the time to offer your thoughts.....I know its lengthy

1Patient on schedule for BCG or DMSO installation; Dr does an exam based patient having a fever after the last treatment and may have to decrease the dosage. Is this a billable EM?

2.Patient seen one week ago, blood taken. Dr relays that TX will be based on results of blood work. Dr calls the patient and advises that he is candidate for Testopel. A visit is scheduled for Testopel insertion; Dr has a conversation in regards to risks/benefits and possible side effects prior to insertion. Is this a billable EM?

3.Patient on schedule for Urodynamics; same day Dr reviews results with patient then develops a TX plan. Is this a billable EM?

4.Patient on schedule for annual cysto; at that visit patient has BPH and prostate exam. Should these be documented in separate notes?

5.In general, when using -25 do you recommend separate notes (1 for EM and 1 for procedure)?

 

[JessH2618]

Our office typically does two separate notes, one for E/M, one for the procedure. If you do find the procedure on the same note, the documentation is very clear that is a procedure. You can easily tell which one is which.

As far as justifying the -25 modifier goes, advice that I was given is that when you are reviewing the chart if you were to remove or black out everything that was related to the procedure that was performed that day, does the documentation left still support the level of service AND is it medically necessary? So going into your scenarios, take 2 for example. I would not think that your doctor discussing risks/benefits and possible side effects justify a separate E/M because it is not separately identifiable. Talking about risks/benefits and possible side effects is something a doctor does to cover himself so that a patient can make an informed decision about the procedure. Also it is important to document medical necessity of a procedure and again, regardless of whether a physician is getting paid separately for that documentation, it is still in their best interests to do so, because if you as a coder have to ask why something is done, and you know what you do in your office, chances are- unless you're very lucky- an auditor is not going to know WHY you are doing a procedure unless it is documented in the chart.