DecisionHealth, DecisionHealth - 2012 Issue 11 (November)
Brush up on modifier 25 knowledge before a private payer audit
Don’t consider work you did to determine medical necessity for a minor procedure a separately identifiable E/M service. In those cases, using modifier 25 (Separately identifiable E/M service) will result in denials or recoupments. Anthem Blue Cross has sent warning letters to California providers who bill E/M codes with modifier 25 “significantly more often than other physicians within the same specialty.”
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