Forum - Questions & Answers

Jul 13th, 2016 - zavalag 3 

Modifier 25 on both Office Visit and Preventative Visit same day as Immunization

Is anyone else having problems with their preventive visits being bundled into the immunization?

25 Modifier is utilized on E/M (office visit) when performed in addition to a Preventative visit on same day. The E/M is being paid as well as the immunizations however; they are now bundling the preventative visit into the immunization.

Is it appropriate to utilize modifier 25 on the E/M as well as the Preventative visit on the same day? It looks like it will bypass the edits however; is it correct coding guidelines.

Thanks.

Jul 14th, 2016 - lesjett 1 

re: Modifier 25 on both Office Visit and Preventative Visit same day as Immunization

We get paid when we bill both a -25 mod on both the preventive service and the OV. I don't know the logic behind it--but it works!

Aug 4th, 2016 - zavalag 3 

re: Modifier 25 on both Office Visit and Preventative Visit same day as Immunization

Adding two modifiers seems to be the answer to bypass the edits however; is it correct coding? With OIG targeting 25 modifiers for overuse, I want to make sure it was acceptable. I cant find anything in writing stating it can only be used once or twice during a visit... it a gray area



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