The article focuses on the use of Modifier 78 by surgeons on a claim form when billing a carrier for the cost of returning a patient to the operating room for management of a complication. This modifier should be used only when the follow-up procedure is performed as a separate procedure ...
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particularly for the role of combining or bundling procedures when appropriate. When the NCCI determines that there is no scenario in which an E/M service can be used with another procedure or service, an unbreakable bundle (category 0) is created. This means that these two codes are always ...
Twitter Google Share on Facebook modifier -25 A code added to CPT coded bills (in the USA) for professional healthcare services that is used to identify a significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other se...
* The procedure code is eligible for separate reimbursement according to the status indicators on the CMS fee schedule for the relevant provider type (physician fee schedule, ASC, OPPS, etc). * The medical records documentation supports the appropriate use of modifier 25. All of the required key...
3. What are the documentation requirements for using Modifier 25? Both the E/M service and the procedure must be adequately documented in the patient’s medical record, demonstrating the need for the separate E/M service. 4. Can the same diagnosis be used for both the E/M service and the...
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Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. ...
If the Relative Value File lists separate line items for a code with modifiers 26 and TC, the service or procedure described by that code includes both a technical and professional component. For instance, the 2015 Relative Value File lists three separate lines for 74020, Radiologic examination,...
Modifier 25 is appropriate when the E/M service provided is distinct and separate from the procedure or service being billed for, such as when a patient receives an E/M service during the same visit as a minor procedure or test. 3. What documentation is necessary to support the use of Mo...