I was hoping for some clarification on when to use modifier 25 in different scenarios. I think my understanding and has been incorrect and I want to remedy that. I scoured the internet and didnt get the information I sought.
So, I have some examples that I hope you can help me with!
1) Office visit (either preventive or sick) with vaccines. I think a modifier 25 would go on the office visit.
2) Office visit and a lab of some sort (lets say a urinalysis). I do NOT think a 25 is needed.
3) Preventive visit and a vision screen. No NCCI edit, so no need for 25. BUT a sick visit and a vision screen WOULD need a 25 as there is a NCCI edit.
4) Preventive visit and screening questionnaire (96127, 96110) would not need a 25 because no NCCI edit. Same for a sick visit.
5) Sick visit with a nebulizer treatment. I think the office visit would need a 25 because a nebulizer treatment is a minor procedure and is above and beyond that of a regular office visit.
6) Well child visit and a circumcision. These would have separate diagnosis codes so I do not think it would need a 25.
7) Sick visit with a shot of antibiotic. 25 of the office visit because the shot is a minor procedure, just like vaccines.
8) If an office visit bumps against an NCCI edit and theres a 1 in the column, do we always do a 25? Or is it a 59? Both?
Sorry for the many examples! I want to be the best coder I can be and am constantly striving to learn more.
Thanks!