Wiki Group practice use of 25 modifier

[cdavis9417]

I work for a hospitalist group. We currently have a spirited discussion going regarding the 25 modifier use. We are a group practice of Hospitalists. Our providers occasionally will perform a separate procedure which may be appropriate for the 25 modifier. The way I understand the use is if the same provider (the provider name is billed out) provides a significant separately identifiable E&M on the same day, then use the modifier not any of the providers from the group practice providing the separate procedure.

Example

If provider A completes the E&M service and Provider B completes the procedure, the 25 modifier from billed provider A (E & M Service provider) because they are in the same group both providers are physicians.

My view is that these are not the same provider and the modifier would not be added. any clarification or information from the community is appreciated.

 

[jimbo1231]

I agree

I think you are correct about the 25. Granted you are billing as a group practice, but the individual provider is identified. And the 25 is used for a separately identifiable E&M when that provider also does a procedure. Sending a claim with an E&M only with a 25 will confuse the payor and might result in in unecessary denials slowing down cash flow.
Do your Hospitalists do their own E&M? I'm trying to get a feel for the breakdown between Hospitalist groups that still do their own E&M and those that use coders. Of course you might be a hybrid where they do their own or use an EMR or CAC and your coders review.

Jim Strafford

 

[cdavis9417]

Thanks Jim (jimbo1231)
Yes our group providers do their own E&M. If our providers do not fare well in our audits they have the option to hire a coder at their expense. (most do not ) Some of our sites use an EMR but for the most part we have them select codes in which we provide education and coders for auditing purposes.