AAPC - Back to school
Results 1 to 4 of 4

Thread: Mod 25 on all E&M claims

  1. #1
    Join Date
    Apr 2007

    Default Mod 25 on all E&M claims

    AAPC: Back to School
    Besides the possibility of triggering an audit, is there any compliance issue for putting Modifier 25 on all E&M' claims, just in case a procedure is done?

  2. #2
    Join Date
    Apr 2007
    Salt Lake City


    decision for the procedure to be done has to be made at the time of the E&M visit, you cant just bill every E&M with a 25.
    Jenifer McPolin CPC, CPMA, RCC

  3. #3
    Join Date
    Apr 2007


    Thank you for your advice. I just learned that some of the billers I work with are doing just that. Besides incorrect coding are there any ramifications, such as compliance fraud, that I can share with the group?

  4. #4
    Join Date
    Apr 2007
    Everett, WA


    I would ask them to tell you WHY they do this. My guess is that they are doing this because 1) someone has told them that this is the way it is always done, or 2) do it this way to get paid. See if any of them can give you a valid response to the use of modifier 25 and it's significance. My bet is that they can't. Then you can rehearse to them the issues of fraud and abuse and how that the OIG is very interested in such billing practices and that they'd better have a good answer ready. Just some thoughts from one who loves E/M but is challenged by it and its modifier companion on a daily basis---Suzanne E. Byrum CPC

Similar Threads

  1. Does cpt 73562 & 73565 applies to this report w/ mod 59 & 26?
    By she803 in forum Interventional Radiology
    Replies: 4
    Last Post: 10-08-2012, 11:44 PM
  2. Version 5010 & Paper Claims
    By QodingQueen in forum Compliance General Discussion
    Replies: 11
    Last Post: 01-16-2012, 02:56 PM
  3. ICD-10 & WC claims
    By BerthaTorres in forum ICD-10
    Replies: 1
    Last Post: 10-05-2011, 06:54 PM
  4. Medicare Mod 25 on 2 seperate claims
    By jasonqdavis in forum Modifiers
    Replies: 1
    Last Post: 10-20-2010, 11:12 AM
  5. mod 25 & mod 59 with a 94664 (inhaler)
    By jsa1517 in forum Modifiers
    Replies: 2
    Last Post: 01-29-2010, 02:46 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.