1. A—Modifier -25 is defined as a significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. It is to be placed on the E/M visit only because it attests to the payer there is documentation to support the medical necessity of billing for an E/M visit and a procedure during the same encounter.
2. C—Both the -50 and the -LT/RT modifiers are acceptable, depending on individual payer policy. Either modifier could be used on a bilateral procedure. The -50 modifier should be placed on the second procedure. The -LT modifier is for the left side of the body, and the -RT modifier is for the right side of the body.
3. C—The modifier -25 would be placed on the E/M visit to attest there was a separate and/or significant reason for the visit besides the procedure. The -59 modifier identifies a distinct, different area of the body. The –XU modifier is for an unusual non-overlapping service. You should verify with your payer which modifier, -59 or -XU, is allowed. The claims would be billed as 99214-25, 96361-XU or -59, 96413, 96415, J1745 x 20, J7050. The infusion was stopped because the patient had an adverse reaction. This is why CPT code 96361 with a modifier is allowed. The modifier indicates this was not just an ordinary use of saline to move the drug along, but was used to flush out the patient’s system. It was coded as a subsequent hydration because the infusion was continued; only one initial code is allowed for each infusion, and the chemotherapy code 96413 has the greatest reimbursement. This is allowable according to CPT coding guidelines.