tci Part B Insider - 2021 Issue Q2

Part B Coding Coach: Know the Facts on the Intersection of Same-Day E/M and Allergy Testing

Tip: Take advantage of CMS guidance and manuals. If you’ve read through Medicare guidance and felt confused, you’re not alone. And sometimes the deeper you delve into coding policies, the more nuanced they become, which can cascade into claims quandaries and denials. For instance, take modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service). This perennial favorite is utilized on many a Part B claim, but is also commonly misunderstood and misused — especially on allergy testing claims...

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