tci General Surgery Coding Alert - 2019 Issue 6

Separate E/M: Master Modifier 25 Essentials for Better Pay

Don’t conflate modifiers 57 and 25. Finding both an E/M service and a surgical procedure in your surgeon’s note isn’t a rare occurrence. But with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) misuse a perennial favorite on the Office of the Inspector General’s (OIG’s) Work Plan, you need to conquer the rules of engagement to make sure you submit only clean claims. Beware: “The OIG reviews use of modifier 25, and...

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