Forum - Questions & Answers

Jun 2nd, 2011 - medicalcoder519

99215 and 99396

When billing 99215 with 99396, do both codes need modifier 25?

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Jun 2nd, 2011 -

re: 99215 and 99396

Yes, We need to append modifier 25 to 99215.

But do remember that the service should be separately identifiable E&M service was provided by the same physician on the same day as the preventive medicine service.

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Jun 2nd, 2011 - jschmutz   323 

re: 99215 and 99396

No, only the E/M code receives the 25 modifier but like the person stated above, the E/M is only separately reportable if it is significant and separate from the procedure.

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Feb 23rd, 2013 -

re: 99215 and 99396

The responses are unclear. Both 99215 and 99396 are E/M codes. The question is which one gets the modifier 25?
If the patient presents for their comprehensive / routine visit and something unexpected or peripherally related to the reason for the visit comes up that must also be addressed, then where does the modifier go? The chief complaint is addressed in the 99215, the ancillary matter is 99396:Which gets the modifier?

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Feb 26th, 2013 - Codapedia Editor 1,399 

re: 99215 and 99396

Look at the CPT® book, at the start of the section on preventive medicine services and you will see that the modifier goes on the problem oriented visit. The CPT® book often answers these types of questions if you read the editorial comments.

I would strongly recommend that you do not report 99396 and 99215 together. There is to much overlap in the services. The history and exam for the 99396 and 99215 will be similar. You will not meet the MDM requirements for 99215. This is an invitation for denial and audit.

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