tci E/M Coding Alert - 2014 Issue 3

Reader Question: Gotta Have That HEM

Question: A patient came into the office to see our orthopedist to receive a knee injection. The patient has had injections from this physician in the past. Can I use modifier 25 on this claim?New York Subscriber Answer: If you have sufficient history, exam, and medical decision making (HEM) to support billing a separately identifiable service, you can use 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) on this claim. The E/M service should be separately identifiable...

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