Decoding the Mysteries of Modifier 25

Modifier 25 - Appropriate Use with Examples to Reduce Claim Denials!

Modifiers are a big part of billing, coding, and claims processing. Modifiers allow us to share with insurance carriers’ information necessary to adjudicate claims for reimbursement. Some modifiers are scrutinized more than others because of the frequency in which they are used, and/or the misuse of certain modifiers. When reporting evaluation and management services, one modifier available to tell the story is Modifier 25. It can only be used for sharing information related to codes 99202 - 99499. It tells the insurance company that the visit is a separately and significantly identifiable service from a procedure(s) that is also performed on the same date of service that has a 00 or 10 day post-operative period assigned to it.  This is where the confusion comes in as to when it is or isn’t applicable. 

Join us for this information-packed webinar with industry expert speaker Lynn M. Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC and review the real and full description of modifier 25 thoroughly to have a clear understanding of its purpose. Even when you believe the modifier was assigned to an evaluation and management visit correctly, it is very common to receive a claim denial when it is reported with a procedure(s). Lynn will also discuss what you need to do to appeal that denial with proven results.

Reference materials used in this session will be CPT and the CMS NCCI Policy Manuals.

Webinar Objectives

Evaluation and management services are the top service performed in offices, hospitals, and other healthcare facilities. The problem with modifier occurs when evaluation and management visit and procedure(s) are related. According to the NCCI Policy Manual published by CMS, there has to be a very unrelated procedure(s) performed in order to correctly apply the modifier 25. During the webinar, Lynn will discuss not only different interpretations of this policy but will also look at real life examples for using Modifier 25 both right and wrong. 

Webinar Highlights

• Full description of modifier 25
• When modifier 25 should not be used
• Documentation that is necessary to prove a modifier 25 is pertinent
• Understanding similar modifiers that can be used for evaluation and management services
• Process for the working of a denial
• Follow-up process to be certain clean claims are reimbursed

Who Should Attend

• Coders
• Billers
• Denial Reps
• Claim Adjusters
• Case Managers