Beware: Modifier 25 Could be DOA


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The Current Procedural Terminology ® (CPT) definition of Modifier 25 is that it is used to report an evaluation and management (E&M) service on a day when another service was provided to the patient by the same physician or other qualified healthcare professional. Think of Modifier 25 as a “protective” modifier when minor procedures or services are performed on the same date as an E&M office visit. If both services are medically necessary, both are paid, if the Modifier 25 has been appended to the E&M.

Recently, though, several payers, including Horizon Blue Cross in New Jersey, Horizon Medicare Advantage Plans, and Cigna Healthcare, to name a few, are now scheduled to cut provider payments when a Modifier 25 is used, creating burdensome paperwork to delay claims.

Since this late-breaking news is a developing story, we have asked nationally recognized professional coder, auditor, and consultant Terry Fletcher to report on its impact on physicians during the next live edition of Talk Ten Tuesdays.

The live broadcast will also feature these other segments:

  • Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will report on the latest coding news.
  • Talk Law: Brianna J. Santolli, Esq., a healthcare and litigation attorney with Riker Danzig LLP, will continue with the broadcast’s newest segment.
  • News Desk: Timothy Powell, CPA, a consultant with Besler, will anchor the Talk Ten Tuesdays News Desk.
  • Journaling John: John Zelem, MD, FACS, founder and CEO for Streamline Solutions Consulting, will continue with his second journal entry in this new segment.
  • Point of View: Susan Gatehouse, a guest cohost who will be substituting for Dr. Erica Remer, will report on a current healthcare topic that has caught her attention.

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