tci Medicare Compliance & Reimbursement - 2013 Issue 24

Reader Question: Modifier 25 Trumps 59

Question: Our payer is denying a claim involving an E/M and a fine needle aspiration (FNA) of a bone lesion with modifier 59 for an improper modifier. Is my modifier use appropriate? Answer: Most payers, including Medicare carriers, require modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service) on an E/M service reported with a minor procedure, such as an FNA of a bone lesion. You should consider procedures with a 0- or 10-day global period as minor procedures &mdash...

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