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Mod 25 Necessary

carlosdela

Guest
Messages
1
Best answers
0
Modifier 25 states: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.

We all know that mod 25 is appended to the E&M or preventive code, but will it really make a difference for insurance payment if no modifier is appended and a procedure is performed with the E&M?
 

RebeccaWoodward*

True Blue
Messages
3,126
Location
North Carolina
Best answers
0
Yep...If it is a separate, identifiable E/M, chances are, the insurance company will deny the office visit as inclusive into the surgical procedure. This happens to us when the poster forgets to add this modifier.
 

ciphermed

Guru
Messages
194
Best answers
0
mod -25

I agree... the modifier should be appended when appropriate otherwise the reimbursement may be negatively impacted (item not paid). Modifier -25 applies to both facility and physician coding.
 
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