Medical Billing Forum
Billing => Billing => : sls April 21, 2011, 12:02:39 PM
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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.
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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...
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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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