Otolaryngology Coding Alert

In October 2000, version 6.3 of the national Correct Coding Initiative (CCI) added more than 50,000 edits for E/M services and diagnostic tests performed on the same day. Providers were instructed to 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 any E/M service performed on the same day as a diagnostic test. Otolaryngologists were particularly affected by the new edits, especially when audiology or allergy tests were performed on the same day as an E/M service.
 
By January 2001, the edits were suspended, pending review by CMS. Any claims denied following the introduction of version 6.3 may be refiled, according to CMS. Claims must be refiled within a year of submission of the original claim. Because the edits became effective Oct. 1, 2000, the one-year deadline will soon arrive. Dont forget to refile claims made between Oct. 1, 2000, and Jan. 1, 2001, as soon as possible.
 
Note: Some Medicare carriers have not changed their software and may require that modifier -25 be attached to E/M services performed with diagnostic tests even though the edits were suspended. Otolaryngologists should ask  their Part B carriers if the modifier is still required.