tci ED Coding & Reimbursement Alert - 2018 Issue 5
Modifiers: Last-Minute Change Saves Practices from Further Modifier 25 Pay Cuts
Tip: Use this as an opportunity to review your modifier 25 processes. Emergency departments are accustomed to reporting modifier 25 every day, since most ED physicians have to evaluate a patient thoroughly before performing any procedures. Fortunately, EDs escaped a near-miss recently, thanks to one insurer's last-minute decision not to slash pay for E/M codes appended with modifier 25. Background: Last year, Anthem announced plans to cut pay for E/M codes appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure...
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