Wiki Two E/M with 25 modifiers

[encomma-watson]

I have a question - a patient has a complete physical 99395-25 and Office/Outpatient Established 99214-25 on the same day. The diagnosis codes are Z00.00 (which is on the first line). On the second line, the diagnosis codes are J18.9, K65.1, S36.039D, E66.09, Z68.34, Z23, Z90.81 and Z09 which will go with 99214.
Should I just leave both modifiers on (CPT 99395 with 25 modifiers on or take the 25 modifiers off) using diagnosis code Z00.00 or should I keep the (CPT 99214 with the 25 modifiers with diagnosis code J18.9, K65.1, S36.039D, E66.09, Z68.34, Z23, Z90.81 and Z09).

diagnosis codes, diagnosis coding

 

[csperoni]

From my experience, most payors will want -25 on the 99214. You may want to check with your specific payor what their guidance is.
You definitely want to link only the appropriate dx codes to each service.

diagnosis codes, diagnosis coding

 

[Cynthia Hughes]

I have a question - a patient has a complete physical 99395-25 and Office/Outpatient Established 99214-25 on the same day. The diagnosis codes are Z00.00 (which is on the first line). On the second line, the diagnosis codes are J18.9, K65.1, S36.039D, E66.09, Z68.34, Z23, Z90.81 and Z09 which will go with 99214.
Should I just leave both modifiers on (CPT 99395 with 25 modifiers on or take the 25 modifiers off) using diagnosis code Z00.00 or should I keep the (CPT 99214 with the 25 modifiers with diagnosis code J18.9, K65.1, S36.039D, E66.09, Z68.34, Z23, Z90.81 and Z09).

I see that you have Z23 (encounter for immunization) in the diagnosis codes billed. Was there also an immunization administration code billed? If so, the modifier 25 is appended to 99395 due to bundling of 99395 with the immunization administration code. Modifier 25 is also appended to 99214 to designate the significant and separate E/M service on the same date as the preventive service reported with 99395.
Cindy

diagnosis codes, diagnosis coding