Office Visit & Procedure on Same Day – Using Modifier 25

Question:

We frequently do a flexible laryngoscopy (31575) or nasal endoscopy (31231) when we see a patient. We always bill the office visit code with modifier 25. Lately, we seem to be getting more denials and have to send in our note for justification. We don’t always get paid. Can you shed any light on this issue?

Answer:

Good question and our clients are telling us they are also seeing more denials for modifier 25. The answer is long and complicated which is why Kim is doing a webinar on proper use of modifier 25 on March 23, 2022. In general, frequently it is appropriate to report both an E/M code and the minor procedure on the same day for new patients. However, for established patients where you’re evaluating them for the same problem and you do the procedure it may only be appropriate to report the procedure code if you are not changing the plan of care or doing any additional medical decision making.

Be sure to sign up for Kim’s modifier 25 webinar here:https://karenzupko.com/using-modifier-25-in-otolaryngology-rewards-and-ramifications/. And, remember, the 2nd edition of Kim’s ENT coding book was recently published – you can order it here and get the KZA discount:https://karenzupko.com/the-essential-guide/.

*This response is based on the best information available as of 03/10/22.