Otolaryngology Coding Alert

Justify your claims by keeping these points in mind.

Before submitting a claim with modifier 25 appended to the E/M code, keep a few tips in mind:

• Remember that modifiers are used to explain circumstances to the payer, and might affect how you’re reimbursed. Ensure that the modifiers and procedures you report tell the full story of what was done.
• Always link modifier 25 to the E/M service code, not a CPT^® procedure code (10000-69999).
• You aren’t required to report two separate diagnosis codes, although the note will better support the 25 modifier if there is an “unrelated” diagnosis connected to the EM.
• The provider should thoroughly document both the E/M care and document the procedure performed on a separate procedure note.