Modifier 25

If a patient comes in with bronchitis (for example) and is given an antibiotic injection can you bill the office visit with a 25 modifier and the injection? Does there have to be another diagnosis that is in no way related to the bronchitis in order to legally bill with modifier 25?

Modifier 25

Modifier 25 does not need a different diagnosis code.
The Medicare Claims Processing Manual reads: “Medicare will pay for medically necessary office/outpatient visits billed on the same day as a drug administration service with modifier -25 when the modifier indicates that a separately identifiable evaluation and management (E/M) service was performed that meets a higher complexity level of care than a service represented by CPT code 99211….For an E/M service provided on the same day, a different diagnosis is not required.”

Modifier 25

Thank You so much for clearing that up for me! I misread the guidelines but I understand now :-)