decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 1 (January)
Understanding E/M: New patient E/M codes and modifier 25
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Article Overview
This article addresses documentation and Medicare compliance issues related to new patient evaluation and management services when another physician has already seen the patient the same day. It is intended for coders, billers, and providers who need a general understanding of modifier 25, supporting documentation expectations, and audit risk considerations.
Why This Topic Matters
Accurate documentation and compliant use of evaluation and management services can affect claim payment and audit exposure, especially when a procedure and an E/M service occur on the same day. The article summarizes guidance from CMS-related sources and OIG findings that are relevant to practices handling these claims.
What You Will Learn
- What documentation elements are emphasized for new patient evaluation and management services
- How same-day procedure scenarios relate to modifier 25
- Why documentation retention matters in the event of an audit
- What types of supporting records are referenced by federal guidance sources
Who Should Read This
- Physicians
- Medical coders
- Medical billers
- Practice managers
- Compliance staff
Modifiers Discussed
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