Modifier -25 Under the Microscope

When reporting codes in CPT, modifiers are an absolutely integral part of correct coding. Modifiers are the key to reporting services and procedures that have been altered in some way without changing the basic description of the CPT code. This means that modifiers are vital in the coding and billing process. However, their individual rules and uses can be confusing, misunderstood and frankly just overwhelming! For example, there are some modifiers that can only be used with procedures, while others can only be used with E&M services. And let’s not forget that payors have their own rules regarding the used of modifiers. In this course we will be looking in detail at one of the most high risk modifiers – modifier -25. In this course we will be putting  modifier -25 for significant, separately identifiable E&M service under the microscope in order to gain a better understating of how and when it should be used. The key to successfully managing the use of this modifier is to understand its in and outs and to put that knowledge into practice.

Topics include:

• Why modifier -25 is important for coding and billing
• The link between modifiers and documentation
• How to  determine the need for a modifier -25
• How to sequence modifier -25 with other modifiers
• We will also look at some case studies

Attendees will be able to:

• Apply firsthand knowledge to effectively append modifier -25 using best practice techniques.
• Recognize inappropriate modifier use and perform corrective action as needed.
• Explain the use of modifier -25  including areas of risk and how to mitigate these risks.