Mod 25

[Donna Lambert]

Hi Everyone,
A patient comes in for a regular office visit that has been schedule. She has back pain. At the end of her visit, she decides she wants to have her spinal stimulator adjusted. Can we bill with the e/m along with the adustment code 95971 with a modifier 25? It's related it's all related to her back.
-Thanks
Donna L.

 

[Alicia Scott]

What is the CC for her scheduled visit? It is back pain? If the back pain is not related to the stimulator you might be able to do this. It would most likely depend on the Ins. Co. as to what they would say. One thing to note though, using -25 you have to have VERY good documentation as to why it is separate. This is a red flag for auditor.

 

[Laureen]

We discussed this in the webinar last night too. If you have separate and significant EM service from the procedure you certainly can bill both unless guidelines for the procedure code tell you otherwise. You should run your code pair through an encoder like http://findacode.com to make sure it doesn't hit a bunding/CCI edit. Here is a quick video showing you how I do that: