Week 1 – Industry Hot Buttons!
Modifier 25: Modifier 25 landed itself on both private payer and the OIG hit lists again this year for overuse and blatant misuse leading to millions in overpayments – and everyone wants their money back! Applying Modifier 25 incorrectly can cost your practice tens of thousands of dollars! Understanding this modifier’s appropriate application can be very tricky.
Here are a few questions to consider before sticking that modifier on your next claim:
- Was the patient scheduled to come in for a planned study or procedure only? Did any notable events occur that would affect the service beyond the study or procedure?
- Was the evaluation and management service provided significant and separately identifiable to the procedure or diagnostic study provided at the same encounter?
- Is active management of a significant and separately identifiable illness/ailment with preventive services for additional problems identifiable in the provider’s documentation?