tci Medicare Compliance & Reimbursement - 2006 Issue 21

COMPLIANCE: Prepare Now For Modifier 25 Crackdown

Make sure your documentation is in order before billing separate E/M service.If you weren’t already worried about audits of the 25 modifier, it’s definitely time to start paying attention. Your documentation for the 25 modifier will be under heavy scrutiny soon, judging from Transmittal 954, issued May 19 by the Centers for Medicare & Medicaid Services (CMS). In this transmittal, CMS: · adds the word “usual,” so the guidelines now read: “a significant, separately identifiable E/M service that is above and beyond the usual pre- and post-operative work for the service.” The...

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