Often questions are posed regarding whether to bill an E/M visit on the same day as a procedure and/or other services with modifier 25. Typically, if the E/M service is unrelated to the minor procedure (i.e., for a different concern/complaint), the E/M may be reported separately. When it is Inappropriate to Use: Time preparing for the procedure,advising the patient of what is about to happen, and the interpretation or post-work of the proceduredo NOT qualify as time that can be billed as a separate and significant E&M service. If the providers documentation indicates the encounter included discussions about an unrelated condition or separate existing problem, it supports a separate E/M and applying modifier 25. Some carriers will still bundle payment of theE&M into theultrasound if a 25 modifier is not used. Medicare requires that modifier 25 always be appended to the emergency department E&M code (99281-99285) when provided on the same date as a diagnostic medical/surgical and/or therapeutic medical/surgical procedure (s). Copyright 2023, AAPC Hi, Best to check theMedicare National Correct Coding Initiative (CCI) edits to confirm the bundling of all tests before submitting the claim. Code 93000 has an XXX global and is a diagnostic procedure, not therapeutic. To claim only the professional portion of a service, CPT Appendix A (Modifiers) instructs you to append modifier 26 to the appropriate CPT code. Particularly with modifier 25, clear, detailed physician documentation is key to demonstrating their thought process and supporting the medical decision making (MDM) involved during the course of the treatment rendered. When the immunization administration code is billed with an E/M visit, a modifier code must be appended to the E/M code to ensure that both services are paid when appropriate. Is there a different diagnosis for this portion of the visit? For the following situations, bill the minor surgical procedure code in addition to the appropriate level E/M service: At a follow-up visit for the patients stable hypertension and osteoarthritis, the patient also complains of a troublesome skin lesion that you remove at that same encounter. Modifiers provide additional information to payers to make sure your provider gets paid correctly for services rendered. The hospital billed 88305 and the professional billed with 88305-26. Modifier 25 Primer: Use It, Don't Abuse It, Long-term Follow-up Care for Childhood, Adolescent and Young Adult Cancer Survivors, Roadmap for Care of Cancer Survivors: Joint Report Updates Recommendations, American Academy of Pediatrics Offers Guidance for Caring and Treatment of Long-Term Cancer Survivors, Childhood Cancer Survivors: What to Expect After Treatment, Transition Plan: Advancing Child Health in the Biden-Harris Administration, Childrens Health Care Coverage Fact Sheets, Prep- Pediatric Review and Education Programs, The E/M service must be significant and medically necessary. Interested in more urgent care tips, best practices, and industry updates? The problematic aspect of this is that not all carriers honor the CPT/CCI guidelines for E&M andUltrasound.
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