There is absolutely no need to use 2 dx codes just because you have an office visit and a procedure. You should not be writing these off you should appeal them. Payers make payment decisions decisions based on trends. Trending has told them that rarely is there sufficient documentation to support the parameters of the 25 modifier. You need to appeal to prove you have an assessment that is over above and beyond the procedure. Such as does he include assessment of the opposit sholder and look at the neck and decide a joint injection instead of a muscle injection. If the documentation is not there then it should not be billed. If the documentation supports and it is not paid then you need to appeal!
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