tci ED Coding & Reimbursement Alert - 2005 Issue 1

Remember 3 S's for Trouble-Free Modifier -25 Claims

Significance, separation, and selection will lead you to success Modifier -25 can be your best friend when reporting an evaluation and management (E/M) service on the same day as a procedure or other service, preventing payers from shortchanging you on valuable reimbursement dollars. But to use the modifier correctly, you must be sure that documentation supports your claim for a separate, significant E/M service. First: Be Sure the Service Is Significant To be paid separately, any E/M service you bill at the same time as another procedure must be significant and separately identifiable. CMS policy dictates that all...

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