tci E/M Coding Alert - 2016 Issue 3

E/M Self-Audits: Remember Modifier 25 When Conducting Self-Audits

You need to prove significant, separately identifiable service before employing the modifier. Within the web of E/M issues that could make a practice a target for payer audits, another danger also lurks: modifier misuse. One of the most common reasons practices get nicked by auditors is the improper use of modifiers. “It’s important for everyone to know when to use a modifier, and to use them right all the time,” warns Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, medical coding director at Acusis in  Pittsburgh, Pa. “Adding a modifier just because you know a service...

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