Modifier 25

I am so confused on using modifier 25 to a preventive visit. My claim denied for 99396. Other preocedures that were done on the same date of service were 87220, 87210, and 99000. Preventive visit was not paid but the 87220 and 87210 were paid. Now, can I use modifer 25 to my preventive visit? or what is my other option?

Thank you,
Bhong

preventive

Modifier 25 - Significant, Separately Identifiable Evaluation and Management (E/M) Service by the Same Physician on the Same Day of the Procedure or Other Service. The modifier 25 needs to be used if a separately identifiable evaluation and management (E/M) service by the same provider is done on the same day as a procedure or other service. The modifier 25 is attached to the E/M code, not the procedure code. What diagnosis code was used? Some payers are requiring a -25 on E/M when labs are also done, if this is the case, put modifier 25 on preventive code. Some payers may not pay for prevention (depends on contract). Medicare does not pay preventive service codes, non-covered.

preventive and modifier 25

Were the codes you listed the only ones that were on the claim form? Nothing else?

What was the reason code for the denial? Can you post that for us?

Does the patient have coverage for a preventive service in their contract? A deductible? Or, was it denied for a coding reason? What insurance?

There is no reason to add modifier 25 from a coding perspective.