Wiki BCBS and 25 Modifier

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aaia2011

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We have received a letter from BCBS stating we are over using modifier 25. We have not changed how we use this and wondering if modifier usage or the definition has changed. We do not use this unless we have a separate E/M service. Thanks for any input.
 
Did BCBS perform an audit to come to this conclusion? If not, then they're really just telling you that you use the modifier more than other practices. If your use of the modifier is supported by documentation, then it shouldn't be a problem. If they did do an audit and identified this as a problem, then I'd ask to speak with someone and get more information about what they're looking for from you.
 
I'll give you a couple scenarios you may be using 25 modifier when you shouldn't.

99213-25
36415
Don't use 25 mod here

99213-25
81025
81002
Don't use 25 mod here

Labs or x-rays don't warrant use of a 25 modifier on the E&M

Use 25 on your office visits only when a minor surgical procedure or injection was performed on the same day.

If someone has conflicting information I'd love to hear it. Thank you!
 
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Thank you for responses. I do not think it was an audit. BUT we will be more careful on usage. We are specialist office and do use with our injections.
 
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