Wiki Modier 25 again

[sallen7113]

We have been told by a Medicaid CMO that we use modifier 25 too much. My provider is an allergist and we perform the allergy testing the same day as the new patient visit.

New visit codes range from 99202-99204 w/25
Allergy Testing 95004

Any suggestions?

 

[Cynthia Hughes]

You might consult your physician's medical specialty organization for any data they have on the use of modifier 25 by their members and how it compares to use by other specialties. As you note, the type of service provided does influence how often the modifier would be appropriately used. It is also reasonable to request information from the Medicaid CMO on whose claims your phyisician's were compared to in their determination that the modifier is used too frequently. If compared to all other physicians and providers, the specialty argument is valid. Hope this helps.