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Good Afternoon!
When billing for an office visit and procedure the same day I normally use the modifier 25 to distinguish it is a separate charge. Recently one insurance in particular is telling me there is a better modifier to use. After research I am not sure which to use. What would you recommend?
Thank you for your help!
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Liz!
Great question. Based on what you described, i would have selected the same 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
What services/codes are included on the claim? That may help us determine other modifier options :)
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Rank: Guest
Joined: 9/8/2012(UTC)
Posts: 54,136
Was thanked: 16 time(s) in 15 post(s)
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The other services are 41010 and 40819.
Thank you for your help!
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Rank: Administration
Joined: 11/21/2012(UTC)
Posts: 1,611
Thanks: 37 times
Was thanked: 46 time(s) in 46 post(s)
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Hi Guest!
No problem! You may consider modifier 51, which stands for - Multiple Procedures
This modifier is used to indicate that the same provider performed multiple procedures—other than E/M services at the same session. You should list highest fee procedure first, and append modifier 51 to the second and subsequent procedures.
Hope this helps!
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