tci E/M Coding Alert - 2023 Issue Q3

Don’t Fall Prey to Common Modifier 25 Mistakes

Getting paid for modifier 25 claims has often been tricky. Check out these pointers on earning the payment your providers deserve. Myth 1: Modifier 25 Is Always Appropriate for Minor Procedure + E/M All billable minor procedures (0-day or 10-day global period) already include an inherent small evaluation and management (E/M) component to gauge the patient’s overall health and the medical appropriateness of the service. Since the decision to perform a minor procedure is included in the payment — the relative value units (RVUs) include pre-service work, intra-service time, and post-procedure time — an E/M service should not...

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