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Otolaryngology Coding Alert

Modifier:

2 Tips To Get Your Modifier 25 Claim On The Right Track

Published on Thu Jul 14, 2011

'Yes' to four basic questions means a separate E/M is billable.Modidifer 25 concerns an E/M service performed with a minor procedure performed on the same patient during the same encounter. This may be the general rule on such situation, but may not apply at all times. First and foremost, you must prove that the E/M is a separate service, not inherent to the procedure. This is because minor procedures include a minor E/M service in their value. In order to be paid for an E/M in addition to the minor procedure, you must demonstrate to the payer that the E/M was "significant and separately identifiable."But the guidelines do not end there. Following these pieces of advice will put you on the safe side of telling when and when not to use modifier 25.1. Present Proof of Separate E/MSince all minor procedure codes have an intrinsic E/M component in them, the [...]
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