Medical Billing Forum

Billing => Billing => : bcotton September 30, 2011, 02:34:52 PM

: modifier 25
: bcotton September 30, 2011, 02:34:52 PM

Trying to get a definitive answer. Should a modifier 25 be attached to an E&M code when an EKG is done the same visit?
Thansk in advance!!!!

: Re: modifier 25
: DMK September 30, 2011, 07:23:54 PM

If there is documented evidence of an actual separate exam, yes.  If the patient just came in for the EKG, no. 

: Re: modifier 25
: Michele September 30, 2011, 11:07:35 PM

DMK is correct, if the patient came in strictly for an EKG then the office visit probably shouldn't be billed.  But if the patient had an office visit and the dr did an EKG, it will depend on the insurance carrier.  Some will bundle it and some won't.  If it was a distinct and separate visit the 25 modifier certainly would be appropriate.

Unfortunately it's not a yes or no question.