DecisionHealth, DecisionHealth - 2009 Issue 8 (August)

Denials remain high for low-level, same day E/M services

Make sure your practice is using modifier 25 correctly when billing an additional E/M service with a procedure. A Part B News analysis of CMS billing data shows denial rates for lower-level E/M codes billed with the modifier are well above 20%. Experts believe you and your peers are appending modifier 25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) with minor procedures such as an injection.

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