Wiki 25 Modifier ONLY to be appended by certified coder?

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CShipitz

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Hello! I am a CPC for the department OBGYN for a large medical group. just spoke with a member of management from the central billing office at my place of work, and they requested that I advise our billers that they may not append the modifier 25 to any office visit if they are not coders. I have never heard tell of this in the many years I have done billing and coding. Does anyone know if this is true? If so, is there a citation where I could see this guideline? I have scoured the web. I can't find a single thing outside of articles that give scenarios of appropriate usage, and I really need to know if we've just been doing it wrong this whole time! Thank you so much in advance!
 
I agree with Carol. Most likely this policy is in place to prevent fraudulent billing practices and the misuse of modifiers by coders that are not certified.
 
There are no official guidelines that require that a certified coder be the one to code medical records. This would include ICD, CPT, HCPCS, or Modifiers. Often times facilities or offices have internal policies that require that only a certified or approved staff member be approved to select, correct, or add coding. In general this is a good policy as this protects the facility or provider from possible coding errors. As we know modifier 25 is one of the codes that OIG is famous for auditing due to the overuse and incorrect assignment of this code.

Ultimately the coding of claims including audits, financial and legal repercussions affect the facility or physician and they are responsible what is done in their name. Because of this many offices have moved to a certified coder only policy. This is completely optional and a provider can set their own policy on who codes.

So you have not been "breaking any official rules or laws" so I would not be concerned on the past issues. Just know that this is a good policy moving forward for everyone's financial and legal well being down the road. :)
 
Chelle-Lynn said:
There are no official guidelines that require that a certified coder be the one to code medical records. This would include ICD, CPT, HCPCS, or Modifiers. Often times facilities or offices have internal policies that require that only a certified or approved staff member be approved to select, correct, or add coding. In general this is a good policy as this protects the facility or provider from possible coding errors. As we know modifier 25 is one of the codes that OIG is famous for auditing due to the overuse and incorrect assignment of this code.

Ultimately the coding of claims including audits, financial and legal repercussions affect the facility or physician and they are responsible what is done in their name. Because of this many offices have moved to a certified coder only policy. This is completely optional and a provider can set their own policy on who codes.

So you have not been "breaking any official rules or laws" so I would not be concerned on the past issues. Just know that this is a good policy moving forward for everyone's financial and legal well being down the road. :)
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This is perfect! Thank you SO much!
 
Thanks, everyone! I was sure that I was going to go crazy trying to find this information! I will call them back and ask if there is an internal policy that I can use for future reference. :D
 
Perhaps they mean that the modifier should not be applied without first making sure is should be applied. If the one performing the billing or looking at denials does not review the documentation then no modifier or code should ever be applied. So perhaps that is what they mean. If the billers are not in the coding department and are not trained as to how to review the document or have no access to the chart notes , then they should not be using the modifiers just to get items to pay.
 
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