Medicare Compliance & Reimbursement

Check out this expert advice to find out how you fared in our modifier 25 quiz. Do your modifier 25 skills measure up to CMS's requirements? You'll find out the answers to our quiz (questions on page 44) below to determine where you excelled. Separate Diagnoses Not Required Answer 1: Medicare does not require that you document separate notes to justify using modifier 25. "What is necessary is that all of the elements of an office encounter are met for the level billed and that the visit does not totally relate to the service or procedure that is performed in the office," says Daniel J. Rogers, practice manager with Gulf South Urology in Biloxi, Miss. For instance, if a male patient presented to a urology clinic for evaluation of urinary frequency and strength of stream while voiding, it would be common for the physician to do a post-void residual study [...]