Wiki Please help a biller settle a dispute with surgeon!!

[arickord23]

I am having a debate with my surgeon over appropriate E&M modifiers and I need some tie breakers!!

A patient was seen today for follow up to RT shoulder pain. (No sx, no fracture, has cortisone injection in February) Today's visit we recommended MRI to RT shoulder to evaluate continued pain after PT and injection.
During this visit, he states that he stubbed his toe a few days ago.
Xrays of the RIGHT foot taken in the office today demonstrate a nondisplaced oblique fracture through the diaphysis of the proximal phalanx of the 5th toe.

We are billing the E&M for the shoulder: 99214
foot xray: 73630 &
fracture care for the toe: 28510

We are "debating" the appropriate E&M modifiers. 24? 25? Both??

Please help!!

Thanks!
Andrea

 

[mray906]

I would use the 25 modifier only.

"Use modifier 25 to indicate that on the day of a procedure or other service identified by a CPTcode, the patient's condition required a significant, separately identiable E/M service above and beyond the other service provided or beyond the standard of pre- and postoperative care associated with the procedure that was preformed"

Hope this helps

 

[jdibble]

You would use only the 25 modifier in this case.

Modifier 24 would be used if there was a global period during which this visit took place - for example if the doctor had done shoulder surgery with a 90 day global in February then you would need the 24 and the 25 modifier on this visit.

Hope that settles your debate!

 

[dlashua]

Modifier 25 is all that is needed.