Wiki Modifier 24, 25, 57

Create Wiki Sort by votes
R

RABBIT2020

Networker
Messages
89
Location
New York, NY
Best answers
0
As a general rule at my place of coding the modifier 25 must be appended to all Evaluation and Management cpt i.e for office vist 99202-99215; 99241-99245; 99221-99233 for commercial insurance billing.
If there is an evaluation and management following a procedures of 90days or 10 days global the modifiers have to be appended 25, 24.
If there is an evaluation and management with decision for surgery 0-90days global the modfiers have to be appended 25, 57.
There are no exceptions for the the modifier 25 regardless if it is the single only service of the day.
I was told it was to avoid rejections from the payer.

Is this a preventative practice at your place of billing and coding?
 
1
Modifiers, just like CPT codes or ICD10 codes, should only be used when appropriate. There is no justification to add -25 on an E/M if it is the only service provided.
Modifier -25 is “Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.”Further explanation of the modifier is given as follows:“The physician may need to indicate that on the day of a procedure or service identified by a CPT code was performed, the patient’s condition required a significant separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding the modifier ‘ -25’ to the appropriate level of E/M service...
 
0
I have seen practices do this a 'preventive' measure, with the reasoning that if there is no other service on that same date that it will not hurt anything since it will not create an overpayment and potentially avoid a denial, but this is still inappropriate - it's simply incorrect coding. If it's being used on every E/M service, how can you know if it's appropriate or not in other situations? I agree with Christine's post - the modifier should only be used when indicated by documentation. I'd add that the downside of doing this is that your practice will show up as an outlier in the modifier use when reviewed by payers and you will be a target for audits.
 
You must log in or register to reply here.
Top