Add-On Codes and Modifiers? - Outpatient Psychiatrist Services

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Circumstance: Patient has TMS treatment (90868) at outpatient psychiatrist office. On that same day the patient has an outpatient office visit with same psychiatrist (99214, +90833).

Question: Before the 2013 coding changes I would bill the 99214 code alone for the visit with modifier 25. I am assuming I would do the same thing now. However, I am unclear if the add-on code also needs a modifier (in this case it would be 59). Do both codes - the primary and add-on - require a modifier to indicate they are distinct, separately identifiable procedures from the TMS treatment? Or does only the primary code (99214) need the modifier since the add-on code (90833) would not be billed as a stand alone procedure?

[camedbill]

I thought you could only use modifier 25 if patient was seen for something else other than TMS treatment?  If they only came in for TMS treatment, wouldn't the codes be mutually exclusive?

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