MEDICAL CODING MODIFIER 25 - Compliantly bill an E&M and separate service on the same date
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- เผยแพร่เมื่อ 18 ม.ค. 2025
- Modifier 25 is becoming widely abused, and is getting hit for review by a lot of insurances! I can break this down for you with some great examples. I explain when modifier 25 can and cannot be used and how it might look trying to explain modifier 25 to a provider.
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I just love you!! I was so stressed over this 25 modifier and you ( through humor at that🤣) explained it better than anything or anyone!!
Hi
This video did help but I also still get confused when speaking about modifiers as a whole… 😬😅
I was looking for a better and more simple description of modifier 25 and you had the best although you talk super fast 😩😩😩😩 you have been the best help and love your videos 👏🏻👏🏻
I love the way you explain things victoria 😊 thank you
You are so welcome!
So Happy To Have Found Your Channel!!!!!!....... Thank you for your work here
I'm happy you found my channel, too!!!!
i WOULD JUST LIKE TO SAY AS A E/M O/P CODER YOU HELPED ME SO MUCH, I LOVE YOUR SCENERIO'S AND EXPLANATION WHY/WHY NOT..THANK YOU!!!!!
Hello girlfriend we Coders really need you so bad out here. Thanks for this video!!!👍🏽🤗😀❤️
🤣🤣🤣🤣 Your roleplaying is the BEST
Working hard to get my CPC. And working a full time job makes it hard for me. Thank God. I have you to help.
OMG this video is so necessary 🙌🙌🙌❗ Thanks for simplifying it so well 😁
very nice with clear understanding
total crack up on the skit action- keep them coming
As long as everyone finds them as funny as I do!
You're awesome! Thank you for your videos! :)
You are so welcome!
So why are the labs and e&m codes are bundled?😊
Good job
I went to an Urgent Care with a sore throat. I asked for a flu test and a strep throat test. I had the flu, they wrote me a prescription and that was it. They billed me with code G0383 (Hospital Emergency Department) with Modifier 25. I asked them two questions: 1) What was the separately identifiable thing in this visit? and 2) Are you allowed to put Modifier 25 on a non E/M code? They said the "separate" thing was the "decision to use the lab to get a strep test." They also said it was accepted practice to put Modifier 25 on the facility code, G0383. Before I appeal to insurance, can you tell me if they might be correct in what they told me? BTW I was talking to the highest level leadership of a major hospital's coding department.
what about if they were a new patient and is having cerumen removal? Thank you for answering this question.
NCCI Policy Manual Chapter 1 - www.cms.gov/files/document/chapter1generalcorrectcodingpoliciesfinal11.pdf
"If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general, E&M services performed on the same date of service as a minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service *unrelated* to the decision to perform the minor surgical procedure is separately reportable with modifier 25. The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. *The fact that the patient is “new” to the provider/supplier is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure.* NCCI contains many, but not all, possible edits based on these principles. "
Hey Victoria! I’ve been struggling with joint injections and E/M office visits charged on the same day. I’ve done some research, and I’ve seen some websites that state if a patient comes in with with a new complaint (such as right shoulder osteoarthritis), and then the provider and patient decides to go forward with a joint injection, the visit would qualify for an E/M office visit and the procedure code (20610) just because it was new complaint that hasn’t been addressed before. Is this accurate?
So I'm kind of stoked right now. We have our provider and another provider billing for 99223 on same date of service. Two different specialties. How do we submit claim if being denied for frequency denial 151? 25 mod or only the admitting provider submits initial code and we submit subsequent? This has been an ongoing issue.
Question : if a comadin patient comes in to get their lab work, they discuss results will patient and change his meds .. do I add modifier 25
Modifier 25 is used on an evaluation and management service when a separately identifiable procedure is performed on the same day. In the description you provided, I am not seeing that a procedure billable with a CPT code was provided and therefore modifier 25 would not be necessary.
UHC is sending out education services to ortho practices stating to put mod 25 on e/m when billed with radiology. What are your thoughts? This is not something they do.
Hello do we bill a modifier 25 when getting a urine analysis
And a strep?
Depends on what else is being billed. Check for a CCI edit.
Hi...I have a question...when we bill e and m...along with venipuncture code...do we always need to add 25 mod with e and m code... please let me know...t 🙏
Where will I use GC modifier???
www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/teaching-physicians-fact-sheet-icn006437.pdf
Love from tamilnadu India ❤️ what is a different between modifier CR and CS 🤔🤔🤔
Can you draw this 😅in so lost with the 25
It's 2023 and I am here for AVOCADO HAND 🥑🥑✋✋
Hello mam