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| 1/14/2021 @ 11:46:00 AM
Post 1 of 2
Contributor: milsomp@acmh.org
This question is about using the modifier 25 for our commercial carriers. Many times a patient will come into one of our office with a problem. The problem will be assessed and an injection or procedure will be done. We would normally code the E/M with a modifier 25 and then the injection or procedure. The history and exam criteria would be used for the E/M level. The MDM would be for the procedure. Now that we no longer use the history and exam to score the E/M level, would it be appropriate to use the E/M with the modifier 25 along with the injection or procedure? 1/14/2021 @ 12:35:00 PM
Post 2 of 2
Contributor: Patty Harper, InQuiseek Consulting
You may use -25 if you have a separately identifiable E & M service on claims. That has not changed. Also, although history and exam do not contribute to the level of the service, those elements of clinical documentation would still need to establish that there was an E & M service as well as a procedure. The new guidelines still require medically appropriate documentation of history and exam.
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