AMA CPT® Assistant - 2004 Issue 11 (November)

Modifier 25: Making the Right Decisions, Part I (November 2004)

November 2004 pages 5-8 Coding Communication:Modifier 25: Making the Right Decisions, Part I This is the first part of a two-part article relating to new information on guidelines for use of modifier 25. Since its inception, CPT Assistant has featured many articles reviewing and clarifying the guidelines for use of modifier 25. Because this modifier is one of the most frequently submitted-generating $1.7 billion dollars in Medicare payments alone in 2001-and falls within one of the areas targeted for investigation in the Office of Inspector General’s 2004 Work Plan, this article reviews the essential guidelines necessary for...

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CPT® Assistant content is the official source for CPT® coding guidance. It is an instrumental tool when appealing insurance denials and validating coding to auditors. Monthly issues and an extensive archive provide comprehensive guidance on proper CPT® coding for past, present and upcoming code set releases. Archives date back to 1990 for historical use of codes, changes, rationales, coding tips and trends in the industry.

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