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3 Ways to Ease Modifier 25 On Your Medical Billing Claims

3 Ways to Ease Modifier 25 On Your Medical Billing Claims

The AMA provides some helpful clarification on when to append modifier 25 in CPT 2006, but you might still need a little more information on how to ace those claims. Here are three tips to help you out.

Report only significant services. In order to gain separate payment for an E/M service, the physician provides at the same time as he or she provides another service or procedure, the E/M service must be significantly and separately identifiable. All procedures include an inherent E/M component according to CMS guidelines. Any E/M service you report beyond that must be above and beyond what is normally included with that procedure or service. Always ask yourself if you can find a clear history, exam, and medical decision making in the notation. If so, you have a separately billable service with modifier 25.

Document the E/M service separately. Physically separate the documentation of the E/M portion of the service from other procedures or services. This demonstrates to the payer that the distinct nature of the E/M service. The surgeon should document the history, exam, and MDM in the patient’s chart and record notes from the procedure on a different sheet that is attached to the chart.

Always include a diagnosis for the E/M. You must link the service to a diagnosis that explains the reason that the service was performed. The E/M service doesn’t have to be unrelated to other services or procedures provided on the same day.

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