tci ED Coding & Reimbursement Alert - 2018 Issue 3

Reader Question: Avoid Modifier 25 for Multiple Procedures

Question: We performed a nail bed repair and an arm laceration repair during the same encounter for a patient who fell and landed on her arm. We billed 11760 and 12001-25 but the wound repair was still denied. Can you advise? Supercoder.com Subscriber Answer: Although 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 or other service) is exceedingly helpful when reporting an E/M service that is separate and significant from a procedure or service at the same encounter, it is...

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