Medical Billing - Think Before You Use Modifier 25 !

Modifier 25 is frequently used in the wrong context -- sometimes mistakenly but more often as a result of purposeful attempts to increase a practice's level of reimbursements. The modifier is clearly defined as an identifiable evaluation and management (E/M) service performed by the same physician and on the same day as the initial procedure. However, many attempts have been made to stretch this definition in recent years, with some practices trying to use modifier 25 for situations in which the E/M service was performed by someone other than the physician responsible for the procedure in question. The consequences for misuse of modifier 25 can be great, especially now that the Office of the Inspector General has increased scrutiny related to the modifier's use and frequent abuse. Avoiding abuse of modifier 25 does not have to be difficult; it simply takes a thorough understanding of the situations in which the modifier is appropriate. Use the following guidelines to ensure full compliance: Medical Necessity Smaller procedures often involve quick examinations of the patient, but these are generally included as a built-in part of the procedure. However, in certain circumstances, the patient may require a separate and more thorough examination. If modifier 25 is used for a separate examination, this exam must be considered a medical necessity, without which safe execution of the procedure would be impossible. For insurance purposes, this medical necessity may be identified by t...
Source: EMR EHR Blog for Physicians - Category: Technology Consultants Authors: Source Type: blogs