sherring1
Contributor
I would like some input on using modifier 25 with an E&M code on the same day as spirometry. My physicians are pulmonary specialists. I know that there is an NCCI edit associated with this, but I would like opinions, please, on these scenarios and whether you feel that a 25 modifier is justified:
1)Patient presents with cough and history of COPD. Physician documents history, exam, and mdm; orders and interprets spirogram, orders and interprets 2 view chest x-ray, reviews records from family physician. prescribes inhaler and orders full outpatient pft's.
2) Patient presents with cough, history of COPD, history of tobacco abuse, and abnormal chest x-ray showing a lung mass. Physician documents level 4 history, exam, and mdm, orders and interprets spirogram, reviews actual x-ray films, reviews old records. prescribes inhaler, orders CT scan of the chest, and schedules the patient for a bronchoscopy with biopsy.
3)Patient presents with dyspnea, wheezing, congestion, and complaints of excessive daytime sleepiness with snoring and witnessed apneas. Physician documents history, exam, and MDM. Physician orders and interprets spirogram, orders and interprets chest x-ray. prescribes inhaler, nasal spray, and orders outpatient 2 night sleep study for suspected sleep apnea.
Am I on the right track in thinking that all of the above represent work that is 'above and beyond' the usual pre-and post procedure work of the spirogram and warrants the addition of modifier 25 to the E&M code?
1)Patient presents with cough and history of COPD. Physician documents history, exam, and mdm; orders and interprets spirogram, orders and interprets 2 view chest x-ray, reviews records from family physician. prescribes inhaler and orders full outpatient pft's.
2) Patient presents with cough, history of COPD, history of tobacco abuse, and abnormal chest x-ray showing a lung mass. Physician documents level 4 history, exam, and mdm, orders and interprets spirogram, reviews actual x-ray films, reviews old records. prescribes inhaler, orders CT scan of the chest, and schedules the patient for a bronchoscopy with biopsy.
3)Patient presents with dyspnea, wheezing, congestion, and complaints of excessive daytime sleepiness with snoring and witnessed apneas. Physician documents history, exam, and MDM. Physician orders and interprets spirogram, orders and interprets chest x-ray. prescribes inhaler, nasal spray, and orders outpatient 2 night sleep study for suspected sleep apnea.
Am I on the right track in thinking that all of the above represent work that is 'above and beyond' the usual pre-and post procedure work of the spirogram and warrants the addition of modifier 25 to the E&M code?
