Urology Coding Alert
Reader Questions:
Check Payer Policies for Modifier Use
Published on Wed Jul 13, 2022
Question: Our payers in upstate New York deny urinalysis and electrocardiograms (EKGs) even with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) as bundled. Can you explain what’s happening? New York Subscriber Answer: You need to look at their payer policy to identify why they’re doing that. EKGs do not need modifier 25. Urinalysis doesn’t need modifier 25. So, it seems as though there’s something going on in their payer policies that’s driving that denial.
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