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Otolaryngology Coding Alert

Modifiers:

Avoid Modifier 25 Mishaps With This Expert Advice

Published on Thu Aug 30, 2012

Tip: All procedures include an inherent E/M component.Every time you fail to report a legitimate and documented significant and separately identifiable E/M service, your practice misses out on anywhere from $25 to well over $100.Don't let this happen to you: Here are three tips to help you know when and how to report separate E/M services with modifier 25.Tip 1: Stress 'Significance'To gain payment for an E/M service the physician provides at the same time as a procedure or service, the E/M must be both significant and separately identifiable.Why you need to be concerned: The Office of Inspector General (OIG) released a report that cites widespread misuse of modifier 25 and resulting overpayments by Medicare. The OIG went on to recommend that CMS should "encourage carriers to re-examine their modifier 25 outreach activities and include modifier 25 reviews in their medical review strategies where appropriate."All procedures, from simple injections to [...]
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