Why use modifier 25

For both services, significant pre-service time is dedicated to evaluation: eight minutes for the abscess and 19 minutes for the colonoscopy. If it does not, only the procedure should be billed. She also complains that her left leg has been swelling and she has pain deep in her thigh. Before performing the biopsy on her arm, you take a history related to her complaint of leg swelling with pain and examine the patient, including palpating the lower abdomen and assessing the lower extremities for varicosities and phlebitis.

You counsel her to wear compression stockings and elevate her legs and schedule a follow-up to determine if conservative therapy is helpful. Two separate diagnoses should be reported on the claim. You conduct a detailed history and physical exam including abdominal, rectal, and genitourinary examination. You then perform a diagnostic anoscopy. Your medical decision making is aided by the anoscopy findings but is based on the history and physical exam.

Only one diagnosis should be reported. Example of an encounter resulting in only reporting a procedure code: A woman arrives at your office for a repeat injection of steroid at the base of her right thumb to relieve arthritis pain and swelling. When you bill both codes on the same day will your documentation support both codes? Modifier 25 can be used for outpatient, inpatient, and ambulatory surgery centers hospital outpatient use. Modifier 25 can be used in other situations such as with critical care codes and emergency department visits.

For further information email your questions to coding acc. Here is an example of an appropriate use of Modifier Example 1: A patient visits the cardiologist for an appointment complaining of occasional chest discomfort during exercise. Some Examples of When Not to Use the Modifier 25 Do not use a 25 Modifier when billing for services performed during a postoperative period if related to the previous surgery.

The full neuro exam, history, and medical decision making outside of the laceration issues are separate and distinct, significantly separate and well documented to support the use of modifier A patient visits the cardiologist for an appointment complaining of occasional chest discomfort during exercise. The patient has a history of hypertension and high cholesterol. After the physician completes an office visit it is determined that the patient needs a cardiovascular stress test that is performed that day by the same physician.

So, this visit would be coded as — 25 and As always, the documentation has to support the claim that your office sends to the carrier. An established patient is seen for periodic follow-up for hypertension and diabetes. During the visit, the patient asked the physician to address right knee pain which developed after recent yard work.

Then the physician evaluated the knee and performs an arthrocentesis. The evaluation of the knee problem is included in the arthrocentesis reimbursement.