DON'T FORGET ABOUT THE...
By: Deidre Hampton
Many times, a patient’s “Oh, by the way …” comment turns an encounter that was scheduled as a preventive medicine visit into something more.
According to CPT, separate, significant physician evaluation and management (E/M) work that goes above the physician work normally associated with a preventive medicine service or a minor surgical procedure is additionally billable. The code that tells the insurer you should be paid for both services is modifier -25. Used correctly, it can generate extra revenue.
Modifier -25 indicates that on the day of a procedure, the patient's condition required a significant, separately identifiable E/M service.
***Unfortunately, not all insurers will pay you for the separate E/M service even if you code in compliance with CPT rules. Be sure to have your staff appeal any denied or bundled claims. A review of your documentation by the insurer may result in payment for your work.
The use of modifier 25 has specific requirements.