BC Advantage - 2024 Issue 2

Modifier -25: Interpretation Is In The Eye of the Beholder

Fresh insights from the American Medical Association (AMA) are always welcome when it comes to medical coding policy. Although they have provided previous guidance on the appropriate use of modifier -25, the AMA's Smart Brief on August 17, 2023 also provides perspective from the payor side. As I read this Smart Brief , I couldn't help but smile. I think this is the first time the AMA so clearly references something I have seen for many years – interpretation is nuanced amongst payors.   The past year alone has seen multiple commercial carriers attempting to revise their own existing policies...

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