Mind your modifiers: Anthem unveils modifier 25 policy that could deny same-diagnosis E/M claims

Why This Topic Matters

It matters because payer policy changes can affect reimbursement, denial patterns, and day-to-day documentation and claim workflows for practices that bill evaluation and management services.

Article Sections

1. Anthem’s modifier 25 policy update

   Introduces the payer’s policy change and the types of claims it is intended to affect. Summarizes where the policy is being rolled out and the general concern prompting the update.

2. What the policy means

   Reviews reactions from coding professionals and medical societies, along with concerns about how the policy aligns with existing coding guidance. Also notes questions about how the payer may interpret and enforce the policy.

3. What to do now

   Provides general operational considerations for practices monitoring claims under the new policy. Focuses on review of denials and diagnosis-linking workflow in billing systems.