tci E/M Coding Alert - 2020 Issue Q1

Reader Question: Don’t Modify This E/M Venipuncture Scenario

Question: Should I apply a modifier 25 onto an E/M visit code (992xx) when my oncologist performs a finger/heel/ear stick (36416) and orders labs (or at least 85025)? Alabama Subscriber Answer: No. The visit code 992xx (Office or other outpatient visit …) does not require a modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) when 36416 is billed. There are a few reasons for that: For Medicare, 36416 is not payable service, but other payers may...

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