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tci E/M Coding Alert - 2020 Issue Q1

Reader Question: Take This Advice, Modify Double Dx Decisions

Question: We know that most insurers say separate diagnoses are not required to use modifier 25, but it seems like we never get paid unless we use separate diagnoses for the procedure and the E/M code. Why is that? Florida Subscriber Answer: You are correct in noting that insurers don’t typically require separate diagnoses, but there’s a chance that you aren’t using diagnoses that support the medical necessity for both separate services. When reporting any E/M service, you must link it to a diagnosis that explains the reason the physician performed it, and it’s possible...

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