Do You Know When it’s Appropriate to Use Modifier 25?

Around the offices here at Healthicity, our auditors and educators get more questions about Modifier 25 than any other modifier. Which probably comes as no surprise to any of you. A simple Google search suggests many of you are confused about its usage in Labs, Emergency Rooms, Dermatology and a whole host of other scenarios. Let alone the differences between Modifiers 25 and 59.

So, it should also come as no surprise that in our world of coding and auditing, Modifier 25 is regularly the most misused modifier of them all. And now, to add insult to injury, CMS and other payers are proposing additional changes around the payment for E/M services with Modifier 25, which likely going to exacerbate our confusion. So now, more than ever, it’s crucial for every provider, coder, biller, and auditor to have a thorough, fool-proof understanding of the proper usage of this complex Modifier 25.

Which is why we developed a new webinar aimed at answering many of the questions we get, and set you on the right path to Modifier 25 compliance. It’s titled “Decoding the Mysteries of Modifier 25,” and will be hosted by me, Lori Cox. During the 60-minute presentation, I will look at all of the rules, guidelines, and some case study examples to help you simplify the complex nature of this modifier through:

• Defining “Separately Identifiable” and “Above and Beyond”
• Understanding How Many Global Days a Code Has
• Clarifying Individual MAC Guidelines and Payer Instructions