Mod 25 Necessary

carlosdela

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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*

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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

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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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