tci Part B Insider - 2004 Issue 43

Same Diagnosis OK With -25 Modifier

If you're billing an evaluation and management visit on the same day as another service, you don't have to list a separate diagnosis for the E/M as long as you attach the -25 modifier, contends Mary Brown with OrthoWest in Omaha, NE. "The old school was you had to have a separate diagnosis," says Brown. This requirement vexed coders, but then the Centers for Medicare & Medicaid Services clarified a couple of years ago that an E/M code could have the same diagnosis as another code, as long as you used the -25 modifier to clarify that the...

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