tci ED Coding & Reimbursement Alert - 2007 Issue 7

READER QUESTIONS: Separte Documentation Keys Modifier 25 Coding

Question: I am having trouble with my modifier 25 coding, specifically with my documentation to prove a separate evaluation and management service. Would you offer some advice on how to document my modifier 25 claims?Montana Subscriber Answer: When you are coding an encounter in which the physician provides an E/M service and performs another procedure, you should separate the documentation for both services and make sure there are two distinct processes. If you follow this documentation advice, it  should improve your accuracy on claims containing modifier 25 (Significant, separately identifiable E/M  service by the same physician on the...

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