Resolved Modifier

[BonnieS_3528]

I have started a new job, I have always worked for a solo doctor. I am now working for a company that bills for a federally funded group. My question is I have always added modifier 25 to the office visit when a patient comes in for a wellness and has other issues. I am now being told you add modifier 25 to both the wellness and the office visit.

 

[Lori]

Here’s some quick guidance from CPT: If a new or existing problem is addressed at the time of a preventive service and is significant enough to require additional work to perform the key components of a problem-oriented evaluation and management (E/M) service, you should bill for both services with modifier 25 attached to the latter. Likewise, the Center for Medicare & Medicaid Service’s (CMS) guide to wellness visits states that when you furnish a significant, separately identifiable, medically necessary E/M service with a wellness visit, add the E/M service with modifier 25. “That portion of the visit must be medically necessary to treat the beneficiary’s illness or injury, or to improve the functioning of a malformed body member,”says CMS.

How to know when to bill for both preventive and added services

When a patient brings an additional complaint to a preventive visit, here's how to know whether it qualifies as a separate service and get paid for your work.

www.aafp.org

Medicare Wellness Visits​

MLN6775421 – Medicare Wellness Visits

Provider Enrollment

www.cms.gov

E&M Audit Tool for Medical Coding

Our Free E&M Audit Tools will help you code in various settings such as office, hospital, facility or home. Download it today!

www.cco.us

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