17 Our work differs because it focused on clinical coverage criteria applied before services occur, rather than all-inclusive challenges to reimbursement after a service is rendered. Also, our study design allowed us to detect services that would not appear in submitted claims because coverage ...
However, a separate E/M service may be considered for reimbursement if the patient’s condition required services above and beyond the usual care associated with the procedure or service provided and modifier -25 is appended to the E/M code. None of the usual pre-service, intraservice, or p...
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