tci General Surgery Coding Alert - 2006 Issue 9

CMS Clarifies Modifier 25 Use, Could Issue a Crackdown

Same-day E/M with identical Dx?  You now have ammunition with payers A recent CMS memo can give you a leg up on your modifier 25 claims, but it could also signal increased payer scrutiny. What should you do? Follow the guidelines to a -T- and be extra certain to document the significant and separately identifiable nature of the procedure. Have Evidence of Distinct Service Available When submitting an E/M claim with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) on the same day as another...

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