tci Part B Insider - 2010 Issue 10

APPEALS: Use This Sample Appeal Letter As Ammo in Your Fight Against Modifier 25 Denials

Attach your procedure notes and the OIG's report to pack extra punch. Even if you follow all of CMS's rules in reporting modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), your Medicare payer may sometimes still choose to deny your claim. If you feel you deserve the pay for the E/M service you performed, you should appeal the denial. Alice Kater, CPC, PCS, coder with Urology Associates of South Bend in Indiana, offers the following sample appeal letter (below) as an example of how...

To read the full article, sign in and subscribe to tci Part B Insider.


Keep pace with evolving Medicare regulations with timely analysis of critical updates interpreted in an easy-to-follow, easy-to-apply format. Your subscription to TCI’s Part B Insider will equip you to navigate code and guideline changes, CCI edits, and revisions to modifiers, the fee schedule, OIG target areas, and more.

  • Current newsletters added each month
  • Fully searchable archives - over 4800 articles
  • ALL years/issues back to 2003 organized by year and issue
  • Codes mentioned in articles are linked to Code Information pages
  • Code Information pages link back to related articles

This feature is currently unavailable for online purchase. For more information, please call 801-770-4203 or Contact Us.

demo
request yours today
subscribe
start today
newsletter
free subscription

Thank you for choosing Find-A-Code, please Sign In to remove ads.