Lori
Well-known member
The AMA has a 10 page white paper on Reporting Modifier 25 published this year. You can find it and download it at the below link.
It has a bunch of clinical scenarios where the 25 modifier would be appropriate with an EM and a minor procedure is performed.and both services are supported.
For my colleagues in Otolaryngology, one of the examples is a patient where the doctor decides to perform an unscheduled flexible laryngoscopy because of the patient's gag reflex and he cannot adequately visualize the anatomic structures down the mouth and throat.
Check it out, and save it. Then include a copy of the white paper with appeals when both the 25 modified EM and minor procedure are not paid, and you are explaining to the payer how the documentation shows support for both services and payment to the physician is due immediately!
The AMA, Specialty Societies, State Medical Societies and Independent Consultants like Don Self and myself are working very hard to assist coders and billers through this abuse that is being thrown at us from every direction. It is up to you to use the tools provided to you and fight like heck to make sure that the payers are held accountable for paying what is owed to physicians and other providers of healthcare services! Courtesy of Barb Cobuzzi
It has a bunch of clinical scenarios where the 25 modifier would be appropriate with an EM and a minor procedure is performed.and both services are supported.
For my colleagues in Otolaryngology, one of the examples is a patient where the doctor decides to perform an unscheduled flexible laryngoscopy because of the patient's gag reflex and he cannot adequately visualize the anatomic structures down the mouth and throat.
Check it out, and save it. Then include a copy of the white paper with appeals when both the 25 modified EM and minor procedure are not paid, and you are explaining to the payer how the documentation shows support for both services and payment to the physician is due immediately!
The AMA, Specialty Societies, State Medical Societies and Independent Consultants like Don Self and myself are working very hard to assist coders and billers through this abuse that is being thrown at us from every direction. It is up to you to use the tools provided to you and fight like heck to make sure that the payers are held accountable for paying what is owed to physicians and other providers of healthcare services! Courtesy of Barb Cobuzzi