Sample Letter Makes Appeals Easy

Expect denials for at least some of your claims if you use modifier -25 to justify an E/M service with another separately identifiable procedure or service on the same day. You can make your appeals process quick and easy by using this appeal letter template to collect on modifier -25 charges:
To [name of decision-maker] at [insurance carrier]:

I am writing to appeal the above referenced claim that was denied on ______.

A significant, separately identifiable E/M service was rendered and documented on the same day by the same physician who performed the [minor procedure, diagnostic test, or preventive exam - list code and descriptor]. Modifier -25 was appended to the E/M code to identify that this was a separate service.

Not only was the E/M service significant and separately performed and identifiable, but it was necessary to provide the patient with quality care. The physician deserves to be fairly reimbursed for the E/M service provided as well as [minor procedure, diagnostic test or preventive exam -- list code and descriptor].

Enclosed is medical-record documentation to support the E/M service [list code and descriptor] as well as [minor procedure, diagnostic test, or preventive exam -- list code and descriptor]. Please review these records and promptly send us the correct reimbursement.

I thank you in advance for your prompt attention to this matter.

Sincerely,     

[your name, your title]
-- Template supplied by Erica Schwalm, CPC, reimbursement specialist and compliance officer at Pioneer Spine & Sports Physicians PC in West Springfield, Mass.

- Published on 2004-03-12