tci E/M Coding Alert - 2013 Issue 1

Reader Question: Modifier 25 is Your E/M + Procedure Answer

Question:  Can I bill Medicare for an office visit and cystoscopy on the same day using a modifier 25? California Subscriber Answer: Yes, you can bill a cystoscopy (52000, Cystourethroscopy [separate procedure]) and an office visit such as 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) on the same day as long as the physician’s documentation supports the significant, separately identifiable E/M service. Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or...

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