Wiki 25 and 59 modifier

[ChristineW]

Just starting working for a physician's office. Was told to put 25 modifier on all office visit codes and 59 modifiers on all office procedures/diagnostic tests done in that visit. Sounds like over modifying to me but not too sure. This is all new to me.

 

[ollielooya]

These type of requests always makes me shudder. Do you have any training in coding and or billing? A blanket commandment such as what you were given is not a compliant directive, in fact, it could set up red flags for audits and I'm sure your provider does not want this. Is this what the office has been doing all along? You are correct in your analysis of "over-modifying". There are rules and regulations one must follow for correct application. I guess my post is more of one to offer sympathies that you'd be placed in such a position, and I applaud your efforts to reach out to get some help. Hope others will jump in here. I just don't know how to begin to help.

 

[Lujanwj]

Let me suggested starting with reading the NCCI Policy Manual. That will explain how CMS uses Modifiers which are not the same as CPT in some cases. Start with that and if overwhelmed, you might need to bring in outside help. I'm surprised the office hasn't been audited yet. As ollie said, red flags!


https://www.cms.gov/Medicare/Coding...ndex.html?redirect=/NationalCorrectCodinitEd/

 

[skiboi]

Christine, my hats off to you also, fantastic that you've reached out for help. I take it this is a private practice?
So you would not have the access to a back end scrubber?
Or a tool that we use is called Code Correct, which they promote as a revenue cycle tool. Just a thought.