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Otolaryngology Coding Alert

Clear Up Your Modifier 24, 25, or 57 Confusion With These Answers

Published on Thu May 28, 2009

Here's what to do if you've been submitting the wrong modifier. To avoid denials for an E/M service on the same day as (or during the global period of) a procedure such as a laryngectomy, laryngoscopy, or parotid drainage, try this foolproof method for choosing between 24, 25, and 57. "Using the correct modifier can make all the difference regarding payment or denials by insurance companies," Claudia Stephens, CPC, billing manager for ENT for Children, PA, and president of the AAPC Richardson Chapter in Coppell, Texas. Scenario: Suppose your ENT saw a patient for an E/M service in the office and is going to perform a related, major surgery that evening or the next day. What modifier should you attach to the E/M service? Ask these questions to eliminate the bad choices and select the modifier that will provide the carrier with an accurate picture of the E/M service. Question [...]
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