jennlester71
Guest
I barely just started school for coding, but I have had some experience with codes in general when doing insurance verification, precerts, and cost estimates. Now I am in training sending out clinic charges. I believe sometimes we use the modifier 25 when it may not be appropriate. We have stopped using it and removed the office E/M code for some things, but for other similar things we are still using it.
I am afraid to push the "powers that be" on it because "they" were very adamant about using it. Even when I brought up the "what if scenario" of "What if the patient has the consult regarding this procedure and a week later comes in for the procedure/injection itself" Everything I've read from Cigna, BCBS, UHC, all disallow the modifier 25 simply to bypass an edit and that the procedure code serves as it's own E/M code, that using a separate E/M code with modifier 25 is only supposed to be used if there is a significant, separately identifiable E/M service above and beyond the other service provided.
What ethical responsibility to I have in this? I don't want to jeopardize getting my certification over this. I also don't want to jeopardize my job and be some sort of pariah.
I am afraid to push the "powers that be" on it because "they" were very adamant about using it. Even when I brought up the "what if scenario" of "What if the patient has the consult regarding this procedure and a week later comes in for the procedure/injection itself" Everything I've read from Cigna, BCBS, UHC, all disallow the modifier 25 simply to bypass an edit and that the procedure code serves as it's own E/M code, that using a separate E/M code with modifier 25 is only supposed to be used if there is a significant, separately identifiable E/M service above and beyond the other service provided.
What ethical responsibility to I have in this? I don't want to jeopardize getting my certification over this. I also don't want to jeopardize my job and be some sort of pariah.