Dec 31st, 2014 - cpark0403 3
Confusion re using modifier 25 with an EM visit and 96372
There continues to be confusion about if and when to use modifier 25 with and EM visit and a
96372 for administering a J code medication. I've seen blogs where it's indicated that the modifier rules changed this year and among other information states the following:
OV & J-code Administration for New and Established Patients with 9372
GUIDELINE: Both 25 and 59 modifier needed and the diagnosis must be managed (different dx
on OV and medication dx on administration) 99201-99215 w/ 25 and 96372 w/59.
Our providers are waiting for direction. Dear Editor, please provide a guideline that is current and
correct to help us all!
My thanks, cpare0403