Wiki modifier 25 use with preventative exam

[LuckyLily]

When a preventative exam is performed, 99381-99397 and a person gets an immunization/hearing test/eye exam/etc... then a modifier 25 is put on the preventative exam code.

When a person also has an abnormal finding and a 99212 would be appropriate, I understand to add this with a modifier 25.

My question is, just to confirm, that when billed a 25 modifier will be on both the preventative and other E/M code? Or does the modifier on the preventative come off since the 99212-25 is being billed?

99381-25
99212-25

 

[NiteshlalKoyalkar]

Hi,
lets understand this in different example ,
Pt comes for preventive exam and also complaints for wound in a leg for which provider has did incision and drainage of pus in that wound and has did medical management for this scenario you bill.
preventive exam 99381-99395 with 25
sick visit with 25
i& d with 25

if no procedure is done then bill only sick visit with 25 along with preventive exam with no modifier.

 

[klittle72]

Hi,
lets understand this in different example ,
Pt comes for preventive exam and also complaints for wound in a leg for which provider has did incision and drainage of pus in that wound and has did medical management for this scenario you bill.
preventive exam 99381-99395 with 25
sick visit with 25
i& d with 25

if no procedure is done then bill only sick visit with 25 along with preventive exam with no modifier.

I disagree. Modifier 25 is not to be used on a procedure code (I&D as mentioned above). It is for an Evaluation and Management service, by definition.

 

[klittle72]

When a preventative exam is performed, 99381-99397 and a person gets an immunization/hearing test/eye exam/etc... then a modifier 25 is put on the preventative exam code.

When a person also has an abnormal finding and a 99212 would be appropriate, I understand to add this with a modifier 25.

My question is, just to confirm, that when billed a 25 modifier will be on both the preventative and other E/M code? Or does the modifier on the preventative come off since the 99212-25 is being billed?

99381-25
99212-25

You don't need a -25 on both the preventive and the E/M code. The patient came in for a preventive exam. Assign the -25 to that code. I've billed that way for 18 years with no problems.

99381-25
99212

 

[camillecoder@hotmail.com]

A modifier 25 is added to E&M codes, not procedures.

The concept of the modifier 25 is to identify something that is separately identifiable from the service it is otherwise inherent to. For instance, the preventive plus sick. The sick visit is a component of the comprehensive preventive visit unless it is significant and separately identifiable. As such, the modifier 25 is added to the sick visit to unbundle the service from the preventive.