Health Information Management

Tip: Review your records for use of modifier -25

APCs Insider, April 1, 2011

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A self-audit is one way to ensure that coders are correctly charging for a separate E/M visit and appropriately appending modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service).

Begin by examining how frequently your facility assigns particular diagnosis codes. Separately distinct and identifiable procedures are usually easily identified with a diagnosis, so coders should ensure that they don't overlook a diagnostic statement.

Remember, though, if you can't make two complete operative notes out of the documentation, you don't have enough to bill an E/M service with modifier -25.

Check to be sure modifier -25 is not appended automatically or arbitrarily. Before appending modifier -25, make sure the documentation supports the separate E/M code.
Some facilities hard-code modifier -25 into their chargemaster for ED and clinics. That way the

department is responsible for adding the modifier instead of HIM staff having to code it. Be very careful with this methodology and make sure the modifier is set up correctly in the chargemaster.

The tip was adapted from “Significant, separately identifiable E/M: Modifier -25” in the April issue of Briefings on APCs.



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