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Mod 25 on all E&M claims

  1. Default Mod 25 on all E&M claims
    Medical Coding Books
    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
    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. Default
    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
    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

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