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Oncology & Hematology Coding Alert

Reader Question:

Watch Out for Modifier -25

Published on Sat Oct 18, 2003

Question: Recently our carrier rejected my claim for 99214-25 and 71010. What did I do wrong?

North Carolina Subscriber Answer: Never append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to an E/M code, such as 99214 (Office visit ... established patient ...), when the only other codes for that claim represent ancillary services like x-rays (71010, Radiologic examination, chest; single view, frontal).
 
Also, append -25 only to E/M services and never to a procedure code. This rule seems simple, but in a rush to submit claims, many oncology coders forget the rule.
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