tci ED Coding & Reimbursement Alert - 2006 Issue 7

Use Transmittal to Check On Modifier 25 Changes

CMS says procedure, E/M can still share Dx When an ED physician treats a patient and provides a significant, separately identifiable evaluation and management service, you can report the E/M separately from the other service with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service. ) But you-ll need to be even more vigilant about proving the separate E/M now, because a recent federal directive indicates a crackdown on modifier 25 claims. The lowdown: Documentation for claims using modifier 25 may be under heavier...

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