tci E/M Coding Alert - 2017 Issue 10

Reader Question: Know When to Append Modifier 25

Question: If the physician performs a colonoscopy (45380) on the same day as an initial hospital visit (99221), do we need to append modifier 25 to the 99221? Colorado Subscriber Answer: The full descriptors for the codes you mention are as follows: 45380 (Colonoscopy, flexible; with biopsy, single or multiple) 99221 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: s detailed or comprehensive history; a detailed or comprehensive examination; andmedical decision making that is straightforward or of low complexity ...). According to the Correct Coding Initiative (CCI) Edits...

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