tci ED Coding & Reimbursement Alert - 2018 Issue 3

Reader Question: Multiple Dx Codes Aren't a Necessity for Modifier 25

Question: One of our physicians is of the belief that he must link any E/M encounter that has modifier 25 appended to it with a different diagnosis code than he has on the procedure. This is sometimes creating incorrect claims. Can you let us know if he is right or not? Supercoder.com Subscriber Answer: In this case, the physician is incorrect. Sometimes, a patient will require both a procedure and a separate E/M code. As long as you follow the modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care...

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