tci Medicare Compliance & Reimbursement - 2019 Issue 8

Pocket These Modifier 25 Essentials

Tip: Documentation must show medical necessity. 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) is one of the most misunderstood modifiers and lands many a practice in the denial zone. And since Medicare claims reviews are on the rise, you can’t be too careful when it comes to compliance. Take a minute to register these four quick rules on your road to coding success. Follow these rules, to combat modifier 25 woes: Rule 1: You can only...

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