tci ED Coding & Reimbursement Alert - 2000 Issue 6

Correctly Appending Modifier -25 Can Be a Reimbursement Asset

Modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) has caused coders significant problems since it was created in 1992. Even though CPTs 1999 clarification of modifier -25 added language that makes it much easier for coders to understand when and how to append the modifier, some questions about use and reimbursement still remain. Modifier -25 is used correctly to identify an evaluation and management (E/M) service that is both significant and unrelated to the procedure the physician performed or will perform. Normally, E/M services...

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