DecisionHealth, DecisionHealth - 2012 Issue 6 (June)

Ask a Part B News expert: E/Ms and modifier 25

How do you avoid E/M denials when using modifier 25 (Separately identifiable E/M service) and a surgical code? For example, is there a reason for denying claims billed as 99213 (Level 3 E/M, established patient) with modifier 25 and 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa)? CMS is denying our claims because the “new code edit guidelines are not met for the use of this modifier.” Is that right? How do you document the services so the claims get paid?

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