Wiki Modifier 25 with Drug Screen

[Pmentzer]

When billing an office visit with a drug screen do you need to append a 25 modifier to the office visit?

 

[marvelh]

A modifier on the E/M code is not required when clinical diagnostic lab tests are performed on the same day as an E/M service.

 

[metzger130]

25 modifier

Can you please let me know where you found this information that we do not need a 25 modifier. So I can have it for my documentation. Our pain clinic has it's own lab and we bill the e/m and the drug screen and I want to make sure that the 25 does not have to be on in our case.

Thank you

A modifier on the E/M code is not required when clinical diagnostic lab tests are performed on the same day as an E/M service.

 

[dwaldman]

Metzger130, I not aware of a carrier that believes there is overlap between an E/M and urine drug test. Additionally, comparing to a hospital setting an EKG or MRI and a separate E/M service would require the 25 modifier if the criteria is met. But they don't use the reimbursement concept that G0431 and G0463 for example require any modifiers. I believe this is similar in an office setting.

b) Modifier 25: The CPT Manual defines modifier 25 as a ?significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service?. Modifier 25 may be appended to an evaluation and management (E&M) CPT code to indicate that the E&M service is significant and separately identifiable from other services reported on the same date of service. The E&M service may be related to the same or different diagnosis as the other procedure(s). Modifier 25 may be appended to E&M services reported with minor surgical procedures (global period of 000 or 010 days) or procedures not covered by global surgery rules (global indicator of XXX). Since minor surgical procedures and XXX procedures include pre-procedure, intra-procedure, and post-procedure work inherent in the procedure, the provider should not report an E&M service for this work. Furthermore, Medicare Global Surgery rules prevent the reporting of a separate E&M service for the work associated with the decision to perform a minor surgical procedure whether the patient is a new or established patient.