tci General Surgery Coding Alert - 2004 Issue 9

Reader Question: Here's How to Appeal Modifier -25 Denials

Question: Whenever I use modifier -25 on an E/M service with a procedure code on the same claim, payers deny the E/M service. Should I just stop using this modifier? If I appeal the claims, how can I make sure I get paid for at least some of the claims? Delaware Subscriber Answer: You should appeal your modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) denials because you deserve payment for those E/M services. But before you appeal, make sure you're correctly appending modifier -25. When...

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