tci Medicare Compliance & Reimbursement - 2019 Issue 8

Modifiers: Resolve Modifier 25 Troubles With This Expert Insight

Tip: Recognize the differences between modifiers’ 25 and 57. Most Medicare providers see beneficiaries for E/M visits everyday; however, sometimes those patients also need a procedure during that visit. And with more payers cracking down on modifier 25 claims, it’s critical that you understand exactly how and when to separately report an E/M visit with a procedure. Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) is probably one of the most used modifiers available, but it is...

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