Otolaryngology Coding Alert

Appeals: HIPAA, CPT guidelines may convince insurer to pay up.If an E/M denial lands on your desk, you shouldn't be caught scratching your head. Follow this expert advice to tackle those tricky modifier 25 appeals.1. Check Documentation Meets Modifier 25 Criteria You should first verify that your otolaryngologist's chart note supports billing an E/M with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of another service or procedure). Every procedure has a small E/M built into it, experts say. So you must show that you performed a significant, separate service from the procedure or other service.Example: A patient presents for an allergy injection, such as 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) in the arm. The procedure has a little bit of evaluation in it. To also code an E/M, for instance 99212-99215 (Office [...]