Wiki Critical Access Hospital claims billed with Method II

[fulgham]

For CAH (Critical Access Hospital) claims billed with Method II, does the OCE (outpatient code editor) edit for modifier 25 apply to all charges (facility and professional) on the claim or just the facility charges. Per the OCE edit, if a SI of V or SI of J2 are present with a type S or T procedure, we append modifier 25. Since the facility and professional charges are both on the CAH facility claim, would the modifier be appended to both facility and professional SI v or J2 charges. Example would be an Emergency room visits, codes on the claim are the facility E/M 9928X , Infusion, 99365, and professional E/M 9928X. Append mod -25 to both 9928X charges?

 

[jsz123]

For CAH (Critical Access Hospital) claims billed with Method II, does the OCE (outpatient code editor) edit for modifier 25 apply to all charges (facility and professional) on the claim or just the facility charges. Per the OCE edit, if a SI of V or SI of J2 are present with a type S or T procedure, we append modifier 25. Since the facility and professional charges are both on the CAH facility claim, would the modifier be appended to both facility and professional SI v or J2 charges. Example would be an Emergency room visits, codes on the claim are the facility E/M 9928X , Infusion, 99365, and professional E/M 9928X. Append mod -25 to both 9928X charges?

Our MAC is Novitas and we are finding that they want the 25 modifier included on the profee e/m also. Even when there is a 57 modifier already attached to the profee e/m.