Wiki Usage of Mod 25

[dvance4210]

I am now questioning myself after reading the article in the Cutting Edge regarding the use of Mod 25.

If my physician is requested for a consultation at the hospital regarding a spontaneous pneumothorax and he makes the decision to insert a chest tube on the same day, should the consultation be billed with or without a 25 modifier.

Just need some clarification!

Dorinda

 

[mitchellde]

It truely depends on the documentation, it is not an automatic yes or no. The procedure includes the evaluation necessary to perform the procedure. If there is any additional MEDICALLY NECESSARY evaluation that goes over above and beyond what is needed for the procedure, then you may bill the visit with a 25 modifier.