tci Outpatient Facility Coding Alert - 2016 Issue 7

Modifier Update: Remember These 5 Pointers Before Appending Modifier 25

Tip: It doesn’t automatically apply to all E/M services. Billing for both a procedure and E/M service can add dollars to your bottom line but can also increase your risk for audit. The OIG (Office of Inspector General) will expect to see modifier 25 on these claims, so it’s important to report things correctly from both a revenue and compliance standpoint. Refresher: Your working definition according to Medicare’s Modifier 25 Fact Sheet is Significant, separately identifiable evaluation and management (E/M) service by the same physician on the day of a procedure. And, although modifier 25 is...

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