tci General Surgery Coding Alert - 2018 Issue 1

You Be the Coder: Don't Overuse Modifier 25

Question: Our surgeon saw a patient in the office who was referred by another physician for placing a drug-delivery implant. The surgeon performed a brief patient evaluation and exam before performing the procedure. I billed this with modifier 25 and the claim was rejected - could you explain why? Ohio Subscriber Answer: You don't state what codes you used, so it's hard to know for sure the reason for the denial. However, assuming that you billed the E/M services with a code such as 99201 (Office or other outpatient visit for the evaluation and management of a new patient...

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