Wiki Auditor

[kellynewell]

We are doing a major audit on modifier 25. Here are a couple questions we are being challenged on: Work above and beyond- If you review and xray before doing a procedure, and this xray has to do with the procedure, does that constitute above and beyond? I get if they have to order an xray afterwards, but to just review it to see where to place a cast or do an injection? And if they give a prescription for say pain or infection after the procedure, is that above and beyond, or part of the procedure? Thanks for any guidance on this. Kelly

 

[mms910]

We are doing a major audit on modifier 25. Here are a couple questions we are being challenged on: Work above and beyond- If you review and xray before doing a procedure, and this xray has to do with the procedure, does that constitute above and beyond? I get if they have to order an xray afterwards, but to just review it to see where to place a cast or do an injection? And if they give a prescription for say pain or infection after the procedure, is that above and beyond, or part of the procedure? Thanks for any guidance on this. Kelly

Modifier 25 -

If the x-ray is a normal part of the procedure - then no, its not above and beyond. Prescription for pain - tricky, depends on how good the documentation is... especially saying the pain is above and beyond what is normal.. infection, yes - that is not normal or expected for majority of the outcomes.