tci Part B Insider - 2013 Issue 10

Appeals: Appeal Modifier 25 Denials With Confidence Using These 4 Strategies

Hint: Pay attention to global period assignments. Denials are a part of every practice’s existence. Some denials are warranted, but others may not be justified. With the crackdown on modifier 25 misuse, you may be seeing more denials involving this modifier. Before you chalk it up to a mistake, review the claim and take the following four steps to be sure you aren’t missing out on reimbursement. 1. Check Documentation Meets Modifier 25 Criteria You should first verify that your physician’s chart note supports billing an E/M with modifier 25 (Significant, separately identifiable evaluation and management...

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