tci Part B Insider - 2005 Issue 24

MODIFIERS: AMA Plans Modifier 25 Clarification

Plus: Modifiers 58 and 78 on the slate for clarificationWhen a patient comes in with a set of symptoms for the physician to diagnose before deciding to perform a procedure on the same date, can the physician use the modifier 25 to garner separate E/M pay?This "gray area" has caused some confusion for coders and coding experts, several of whom want to be able to use the 25 modifier when the physician does significant extra work diagnosing the patient.Coding experts cite the following scenario: A patient presents with knee pain that could be due to a number...

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