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using modifier 25

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sls:
i have a cardiologist who is doing a 99214, then doing an EKG.  We are a little confused on the modifier 25, i say if he uses a different diagnosis for the office visit we can use it.  Other billing states, it cant have the modifier 25 because he is a cardiologist and it is not a seperate service.  Any one doing this?  and can we bill it that way.  I thought rule of thumb was if you use a different diagnosis with a procedure modifier 25 can be used to include both. 

sequelian:
Modifier 25 will be use if u r using E&M code with anyother procedure for the same place of service regardless of dx codes...

Michele:
CPT Definition of modifier -25:  Significant, separately identifiable E&M service by the same physician on the same day of a procedure or other service: The physician may need to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E&M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. The E&M Service may be prompted by the symptom or condition for which the procedure was provided. As such, different diagnoses are not required for reporting the E&M services on the same date. The circumstance may be reported by adding modifier 25 to the appropriate level of E&M service. 

Actually, it isn't really based on diagnosis or place of service.  It is based on if the provider feels that the E&M visit meets the above guidelines of being significant, separately identifiable from the other procedure, in this case the EKG.  So if the E&M visit was strictly to perform and read the EKG it wouldn't warrant the 25 modifier, but if the provider covered other things, etc during the E&M then it would.

Hope that helps.

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