Date Issued: 1/28/2016
EmblemHealth follows the National Correct Coding Initiatives (NCCI) policy and requires the use of modifier 25 when an Evaluation and Management (E&M) code is billed on the same date of service as pulmonary testing codes 94010-94799. You and your staff should be familiar with the definitions of CPT 99211-99213 and the correct use of modifier 25, when performing pulmonary diagnostic, therapeutic, or monitoring procedures.
Chapter 11, page XI22 of the 2015 NCCI correct coding policy states: “If a physician in attendance for pulmonary diagnostic testing or therapy obtains a limited history and performs a limited physical examination related to the pulmonary testing or therapy, separate reporting of an evaluation and management (E&M) service is not appropriate. If a significant, separately identifiable E&M service is performed unrelated to the performance of the pulmonary diagnostic testing or therapy, an E&M service may be reported with modifier 25.”
For additional information on the correct use of modifier 25 refer to our Claims Corner posting. More information on NCCI coding rules is available from the Centers for Medicaid and Medicare Services (CMS).