Modifier 25: Cut Confusion, Get Paid More
Modifier 25 is on both private payer and OIG hit lists again this year for overuse and misuse leading to overpayments – and they want their money back.
Modifier 25 is one of only a handful of modifiers listed on the OIG website associated with massive fines, extended exclusions and additional penalties. Recently 3 practices were hit with huge fines (as high as $1.9 million) for receiving reimbursement on claims where modifier 25 was utilized incorrectly. And if you regularly use modifier 25, you can easily get targeted.
The problem is, if your practice performs additional E/M visits and procedures on the same day by the same provider that should be considered separate, modifier 25 is the ONLY way you can accurately get paid for the services you provide and documentation of that additional work is key. Otherwise you are leaving thousands of reimbursement dollars uncollected.
You can get paid for more of the E/M services you provide in addition to minor procedures and avoid getting targeted for a payer audit with some help from national coding expert, Jan Rasmussen, PCS, ACS-GI, ACS-OB. During this on-demand, 60-minute online training session, Jan will walk you through how to more accurately apply this tricky modifier to get paid for more of the services you provide.
Here are just a few modifier 25 questions you’ll get answered during this step-by-step, plain-English online training. By ordering, you’ll be able to overcome the confusion associated with this essential modifier:
• If the patient is scheduled for a diagnostic study only, can
a separate E/M service be reported as well?
• Should I use modifier 57 instead for minor surgeries in
addition to E/M visits?
• What if the additional exam was for something outside of
the immediate problem area?
• What if different conditions (diagnoses) are treated on the
• Is modifier 25 always acceptable for new patients or
• Can I use modifier 25 in conjunction with preventive services
for additional problems identified?
• Can I be paid for an E/M visit performed immediately before
• How can I tell the difference between what’s considered a
major and minor procedure?
• What specific items should the provider include in their
HPI and ROS documentation?
• Do additional diagnostic studies need to be ordered to justify
being paid for the additional E/M service?
• And so many more…
You are not alone if you think modifier 25 is confusing. But it doesn’t have to be. You can get proven expert advice on how to more accurately utilize this essential modifier during this 60-minute online training.
Stop leaving thousands of uncollected reimbursement on the table, and avoid being overpaid for E/M services in addition to minor procedures. More accurately apply modifier 25 and get paid more of what you deserve by ordering this on-demand online training. Don’t wait, order today.
As a health care consultant Jan has more than 35 years of experience in physician billing, reimbursement and compliance. Jan is currently the owner of Professional Coding Solutions, a healthcare consulting firm. She has been a Certified Professional Coder (CPC) since 1992 with active membership in the American Academy of Procedural Coders (AAPC). As a member of the AAPC, Jan previously served on their Advisory Board as the liaison to the AMA, has been a speaker for the AAPC annual conference as well as contributing to the development of AAPC’s independent study and university education programs and proficiency tests. In 1994, she was honored by AAPC as Networker of the Year. Previously Jan was a Regional Governor for the American College of Medical Coding Specialists (ACMCS) serving as Chair of the Ethics committee and a member of the Examination committee.
In her role as a physician consultant, she has participated in physician coding and documentation reviews including OIG government PATH and Champus audits, designed and conducted physician coding seminars nationwide.
Jan has also worked for several major health insurance payers in Wisconsin, was a coding advisor to the WPS Medicare Carrier Advisory Committee and served as the coding and reimbursement coordinator for a 37 provider, staff model HMO clinic. As the coding and reimbursement coordinator, Jan was responsible for physician office, hospital and nursing facility coding, charge ticket development, fee development, reimbursement analysis, claims analysis and physician education.
This program meets AAPC guidelines for 1.0 CEU. On Demand product requires successful completion of a Post-Test for Core A and all specialties except CCPC and CIRCC for continuing education units.
“It was very informative and the examples were very good, it was a very good webinar.”
- Kelly Blanch, Health Center Coding specialist, MDI Hospital, Bar Harbor, ME
- Shelly Robinson, Manager, TOI, Tuscon, AZ
“Presenter provided useful examples.”
- Marsha Schwartzenberger, Billing Supervisor, Northwest Orthopaedic Specialist, Spokane, WA