Understanding The Complexity
of Modifier 25 in Dermatology
Appending modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to an Evaluation and Management (E/M) code, when also billing a minor procedure on the same day, typically results in payment for both services – the reward. But is it correct?
Payors, including the Office of the Inspector General (OIG), have been auditing the proper use of modifier 25 and recouping millions of dollars from dermatologists. A common misconception is that the E/M code and procedure code are always billed together. That’s just not true. There are times when it is not appropriate to also report the E/M code but bill only the procedure.
We will examine the CPT guidelines about using modifier 25 as well as what Medicare says. Several scenarios frequently encountered in dermatology practices will be reviewed. You will have a better understanding of how to correctly use modifier 25 when performed with the common Dermatology minor procedures.
Deborah is a nationally sought after leader in the industry and is passionate about assisting physicians and hospitals in improving their coding, documentation, and business operations to maintain compliance and improve revenue. She will go above and beyond to help industry leaders, physicians and others achieve excellence. Her motto is “documentation excellence is the key to improving revenue.”
Please email email@example.com if you have questions.