DON'T FORGET ABOUT THE...
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.
Reliance Medical Management, LLC
4242 Six Forks Rd, Suite 1550
Raleigh, NC 27609
Reliance Patient Services