Wiki Mod 25 Necessary

[carlosdela]

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*]

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.

 

[mbort]

ditto to Rebecca!!

 

[ciphermed]

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.