tci E/M Coding Alert - 2018 Issue 2

Reader Question: Implant Modifier 25 Into This E/M Scenario

Question: Our surgeon saw a patient in the office who was referred by another physician for placing a drug-delivery implant. The surgeon performed a brief patient evaluation and exam before performing the procedure. I billed this with modifier 25 and the claim was rejected - could you explain why? Illinois Subscriber Answer: You don't state what codes you used, so it's hard to know for sure the reason for the denial. However, assuming that you billed the evaluation and management (E/M) services with a code such as 99201 (Office or other outpatient visit for the evaluation and management of...

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