Neurology & Pain Management Coding Alert

Question: Whenever I use modifier -25 on an E/M service with a procedure code on the same claim, payers deny the E/M service. Should I just stop using this modifier? If I appeal the claims, how can I make sure I get paid for at least some of the claims?

Delaware Subscriber

Answer: You should appeal your modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) denials because you deserve payment for those E/M services. But before you appeal, make sure you're correctly appending modifier -25. When you appeal your claims, send a copy of the chart notes to prove that the E/M service was, in fact, a separately identifiable service.

If payers see your charts on an appeal, they'll probably pay attention to them because the charts explain the reason for appeal. If you still have trouble getting your claims paid, contact the payer's representative. Some private payers may request other modifiers instead of -25 in these instances.