If the patient came in and the doctor performed the 99213, and then decided to perform the 94640, 94760 or 94200 (doesn't matter if it's the same day or a different day), then no.... you wouldn't use mod 25 because that E/M service is a part of the overall service.
Full Answer
What modifiers can be used with CPT 99213?
A healthcare professional uses modifier with a CPT to indicate that the particular service is modified or altered in some or the other way. Below are the modifiers allowed to use with CPT 99213. 25 – Most commonly used modifier. It is used when there is an additional service or procedure performed on the same day.
Can you use mod 25 for 99213 and 94200 on the same day?
If the patient came in and the doctor performed the 99213, and then decided to perform the 94640, 94760 or 94200 (doesn't matter if it's the same day or a different day), then no.... you wouldn't use mod 25 because that E/M service is a part of the overall service.
When should you not use modifier 25 on an E/M?
Do not use a modifier 25 on any E/M on the day a “Major” (90 day global) procedure is being performed. Do not append modifier 25 to an E/M service when a minimal procedure is performed on the same day unless the level of service can be supported as significant, separately identifiable.
Can I apply a 59 modifier to E/M charges?
A 59 modifier would not be appropriate. You could apply a 25 mod on the E/M charge IF the encounter meets the definition " significant, separately identifiable evaluation and management (E/M) service by the same physician on the day of a procedure."
Does an EKG need a 25 modifier?
Yes, you need to add a -25 modifier to your E&M service when billing in conjunction with an EKG or injection admin service done on same DOS. You're sure to get a bundling denial without it.
Does 99213 need a modifier?
If the circumstance calls for a Level 3 established patient visit (CPT code 99213) to be billed with psychological testing (such as CPT code 96101), modifier 59 would be appended to the testing code.
Does Medicare require modifier 25?
Medicare requires that modifier –25 always be appended to the emergency department (ED)E/M code (99281-99285) when provided on the same date as a diagnostic medical/surgical and/or therapeutic medical/surgical procedure(s). Example #1: A patient is seen in the ED with complaint of a rapid heartbeat.
When should a 25 modifier be used?
The Current Procedural Terminology (CPT) definition of Modifier 25 is as follows: Modifier 25 – this Modifier is used to report an Evaluation and Management (E/M) service on a day when another service was provided to the patient by the same physician or other qualified health care professional.
How do you bill an EKG with an office visit?
For example, CPT code 93000 denotes a routine electrocardiogram (ECG) with at least 12 leads, including the tracing, interpretation, and report. If a physician performs only the interpretation and report (without the tracing), they should report CPT code 93010-not 93000 with modifier -26.
What is required for a 99213?
CPT 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity.
In what scenario would you use modifier 25?
Modifier -25 is used to indicate an Evaluation and Management (E/M) service on the same day when another service was provided to the patient by the same physician.
Can an office visit be billed with a procedure?
Can you bill an E/M service on the same day as a minor procedure? Sometimes yes, sometimes no. The decision to perform a minor procedure is included in the payment for the procedure, unless a significant and separate E/M is needed, performed and documented.
What is an example of modifier 25?
If all the requirements are met, modifier 25 can be appended to the E/M code. Example: An established patient was scheduled for their AWV today. Yesterday they fell and hurt their knee.
What is the difference between modifier 25 and 27?
We can use modifier 25 and 27 together, so do not get confuse with both these modifier. Both modifiers are defined separately and so use them correctly with E&M codes. Use modifier -27 for multiple outpatient hospital evaluation and management (E/M) encounters on the same date.
What does CPT modifier 25 mean?
separately identifiable evaluation and management serviceThe Current Procedural Terminology (CPT) defines modifier 25 as a “significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service.”
How do you bill two E&M on the same day?
If a provider sees the patient twice on the same day for related problems and the payer doesn't allow you to report those services separately, then you should combine the work performed for the two visits and select a single E/ M service code that best describes the combined service.
Location of CPT 99213 in CPT coding manual
CPT or current procedural terminology in medical coding is used to track services and procedures furnished by physician, non-physician practitioners, hospitals, outpatient service and allied health professionals.
CPT 99213 Code Description
Office or other outpatient visit E&M code of established patient requires medically appropriate history and/or exam with MDM of low level. When using time for code selection, it requires total of 20-29 minutes on the same date of service.
Selection of CPT 99213
It is important to know the criteria’s on selecting CPT 99213 from medical record. There are 2 ways to select the code – based on MDM and based on time.
What is CPT modifier 25?
The American Medical Association (AMA) Current Procedural Terminology (CPT) book defines Modifier 25 as a significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service.
Why are modifiers needed?
Modifiers are needed to inform third-party payers of circumstances that may affect the way payment is made – the modifiers tell a story of what is being done ! Always link the modifier to the E/M CPT code. It is not necessary to have two different diagnosis codes. Need to document both the E/M and the procedure.