tci ED Coding & Reimbursement Alert - 2017 Issue 7

Reader Question: Check Out This MAC's Modifier 25 Scrutiny Rules

Question: We frequently submit claims 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 or other service) appended, but we've heard that using this modifier sends out red flags with the insurer. Is this true, and if not, what do Medicare payers look for when they're reviewing this modifier? Supercoder.com Subscriber Answer: It can be disconcerting to report a code and wonder what happens to it after you've submitted it, but remember that you have no need to worry about...

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