You should append a modifier 25 significant

You should append a modifier 25, Significant, separately identifiable E/M service by the same physician or other qualified
health care professional on the same day of the procedure or other service, to the E/M code when billed with 90471,
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine
(single or combination vaccine/toxoid). If you perform complete spirometry with a graphic record, code 94010 (Spirometry,
including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary
ventilation).
You can also report an E/M code for the office visit on the claim. Although there is no Correct Coding Initiative that otherwise
bundles 94010 and an E/M code, you may still want to append modifier 25 to the E/M code to indicate that it was significant
and separately identifiable from the spirometry. Your documentation should be able to support the use of modifier 25 and the
need for the separate office visit.
Immunohistochemistry
1. Yes, you can bill technical charge for performing an attempted IHC stain.
Implantable Loop Recorder
1. For professional services, i.e., implanting of ILR implants, your doctor will need to dictate the report for billing.
Incident-to
1. The billing should be under the supervising physician. According to “incident-to” guidelines, there has to be an established
plan of care in order to comply. The provider who set up the care plan does not have to be the billing provider. Any provider
within the same group and under the same tax ID number can be the supervising physician.
2. The scenario that you are describing may fall under incident-to billing. Review the incident-to guidelines to determine if this
visit will fall under the required billing guidelines.
3. You are correct. You are unable to bill under a provider who was not in the office. According to incident-to billing guidelines,
the provider must be immediately available to assist and provide direction if needed. Telephone access is not consistent with
incident-to guidelines. See the incident-to rules at for complete requirements. You can use this as supporting
documentation to give to your provider.
Infusion Pump Refill
1. Use CPT ® code 62369 when Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion
with reprogramming and refill, is performed. Use CPT ® code 62370 when Electronic analysis of programmable, implanted
pump for intrathecal or epidural drug infusion with reprogramming and refill (requiring physician’s skill), is performed. Use CPT ®
code 95991 when Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal with electronic analysis
of pump, is performed; requiring skill of a physician or other qualified health care professional. In this code, reprogramming
is not performed.