Understanding When to Use Modifier -25

Jun 19, 2020 | Uncategorized

This week’s coding conundrum is regarding the Modifier -25. Not all insurers will pay you for separate E/M services even if you code in compliance with CPT rules, but this code can help you get reimbursed for the extra work you do at certain visits. Read below to find out more and contact us today to learn how we can help your business with reimbursements!nnModifier 25 continues to cause problems throughout the industry. It remains one of the most used and often abused modifiers. The Office of Inspector General (OIG) continues to monitor this with their watch list and is the trigger for many practices and provider audits. The problem is that the documentation does not adequately support both services. Remember, “If it is worth an extra reimbursement, it is worth an extra paragraph”. There are several great articles and resources to help maintain compliance with your documentation. This is not a new problem but it is one that continues to be paramount. A great article by the American Academy of Family Physicians (AAFP) from 2004 still is relevant today in 2020. And it is not just Family Practice or Primary Care physicians who are at risk.nnClick here for more information regarding Modifier -25.