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tci Part B Insider - 2005 Issue 17

MODIFIERS: Payers Deny Modifier -25 Claims Unless E/M Is Totally Unrelated

New book may be adding to the confusion Coders are reporting denials for evaluation and management claims on the same day as a minor surgery, even if they use modifier -25. Some payers are citing a recent book from the American Medical Association, Coding With Modifiers, as backing up the association's hard-line stance. The book says you shouldn't use modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) with E/M services "associated with procedures" - unless the E/M is "above and beyond the usual preoperative...

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