Forum - Questions & Answers

Mar 30th, 2016 - donnaulmer 2 

Modifier 25

I am having some problems understanding the use of modifier 25. Is it appropriate to bill for a blood draw in the office a nurse visit 99211 with modifier 25 and then 36415, or should we only be billing for the 36415? Any help in this matter will be greatly appreciated. Thank you in advance.

Mar 30th, 2016 - alpjeffrey 14 

re: Modifier 25

We usually bill a 25 modifier with any E&M code. I don't see anything wrong with billing 99211 - 25 and 36415. Depending on what insurance though, some don't pay for "nurse visits" so therefore we just leave off the 99211 and go straight 36415.

Normally we just leave off the 99211 just to eliminate confusing between which insurances recognize the code. You don't get much reimbursement for it anyway.

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