Health Information Management

Pay-per-view: Providers continue to grapple with reporting modifier -25

APCs Insider, July 10, 2015

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Lately I've received a lot of questions from hospitals about how to determine when and if it's appropriate to report an E/M visit code on the same date of service as a scheduled procedure.
What providers seem to be asking is if it's okay to report the E/M visit code with modifier -25 (significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure or other service), so they can receive separate payment for both the E/M visit and the procedure.
Because I've received so many questions in the space of a few months, I started wondering if something had changed or if some new instruction had come out that I had missed. It turns out that nothing has changed with respect to the definition or rules around when modifier -25 can be used, but CMS expanded packaging for 2015, along with more audits occurring may be the source of the questions.
Continue reading "Providers continue to grapple with reporting modifier -25" on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the July issue.

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