What does modifier 25 mean

A: Modifier 25 is tricky and can always use some important reminders of its proper application. A few rules to remember when using Modifier 1. It is not necessary to have two different diagnosis codes. Proper use of Modifier 25 A new patient presents with head trauma, loss of consciousness at the scene and a 4. So this visit would be coded as follows: The possible neurological damage from the head trauma extended beyond the laceration, which was repaired. Improper use of Modifier 25 An established patient returns to the orthopedic physician with escalating right knee pain 6 months post a series of Hyaluronan injections.

Related Content: Opinion Legal and Policy. The overall effect of modifiers is to alert the payer to acceptable deviations from the CPT coding rules. The modifiers will not be used on all claims; the popular wisdom is that modifier use will be the exception rather than the rule. But there will be times when a modifier is needed. In all cases, physicians should remember that the documentation must show that the two services were separate and distinct. Also from ACP, read new content every week from the most highly cited internal medicine journal.

Visit Annals. Modifier 25 The first modifier to consider is Modifier 59 Modifier 59 identifies procedures or services that are not normally reported together. In this way, modifier 59 is essentially a tool to bypass or override the NCCI edit. As with all matters of provider service billing, understanding the necessity of justification of services performed is mandatory. In a word or maybe three : document, document, document.

Especially with modifier 25, clear, detailed physician documentation is key to supporting the MDM involved during the course of the treatment rendered. The provider must demonstrate their thought process in the required documentation , as it will serve a critical role; without a proper medical record, payers may continue to render determinations of incorrect claim denials or underpayments. Understanding the correct and appropriate use of modifier 25 will be key to filing correct claims, which will then result in correct payment.

Not only does the 25 modifier allow us to code physician services to the highest level of specificity possible, but it ensures the physician is paid accordingly for those services. Procedure Coding: When to Use the 25 Modifier.