Modifier 25 plays a vital role in your dermatology coding practice; as such you need to know the right way to wield this modifier.
Many a time, you find yourself confused while using this modifier with modifier 57; it's a common point of confusion since both involve your dermatologist carrying out a procedure and distinct evaluation & management service for the same patient on the same day.
The most noticeable distinction is that you would use modifier 25 for a distinct E/M with a minor procedure, and 57 for a distinct evaluation & management with a major follow-up procedure.
You should only use modifier 25 with procedures that have a 0- or 10-day global period. These types of procedures are what Medicare defines as ‘minor'. In comparison, you will use modifier 57 for procedures with a 90-day global period. However note that some payers are now requesting modifier 57 on 10-day globals.
Some coders look at modifier 25 as a magic wand and they always add a modifier 25 to evaluation & managements performed on the same day as a procedure since that's the only way they can get them paid. Don't follow this tip blindly and fall into that trap though! Any practice that applies modifier 25 indiscriminately to their E/Ms will be an outlier to other practices in the volume of claims billed with modifier 25 and will be sending up red flags.
Also remember that proper modifier 25 does not call for a different diagnosis code. As a matter of fact, the presence of different diagnosis codes attached to the evaluation & management and the procedure doesn't support a reportable evaluation & management service.
If you go to the CPT manual (Source CPT manual http://www.supercoder.com/cpt-codes/), you will find that the information about modifier 25 indicates that you don't have to have two different diagnoses codes to use this modifier.
How it functions: The proof is in the documentation of the E/M coding. Your dermatologist's documentation should clearly establish that the visit's purpose was not to perform the procedure. If you meet denials on modifier 25 claims simply because you use the same diagnosis code for the evaluation & management and the procedure, you should appeal taking that your dermatologist's documentation supports reporting separate services.
Many a time, you find yourself confused while using this modifier with modifier 57; it's a common point of confusion since both involve your dermatologist carrying out a procedure and distinct evaluation & management service for the same patient on the same day.
The most noticeable distinction is that you would use modifier 25 for a distinct E/M with a minor procedure, and 57 for a distinct evaluation & management with a major follow-up procedure.
You should only use modifier 25 with procedures that have a 0- or 10-day global period. These types of procedures are what Medicare defines as ‘minor'. In comparison, you will use modifier 57 for procedures with a 90-day global period. However note that some payers are now requesting modifier 57 on 10-day globals.
Some coders look at modifier 25 as a magic wand and they always add a modifier 25 to evaluation & managements performed on the same day as a procedure since that's the only way they can get them paid. Don't follow this tip blindly and fall into that trap though! Any practice that applies modifier 25 indiscriminately to their E/Ms will be an outlier to other practices in the volume of claims billed with modifier 25 and will be sending up red flags.
Also remember that proper modifier 25 does not call for a different diagnosis code. As a matter of fact, the presence of different diagnosis codes attached to the evaluation & management and the procedure doesn't support a reportable evaluation & management service.
If you go to the CPT manual (Source CPT manual http://www.supercoder.com/cpt-codes/), you will find that the information about modifier 25 indicates that you don't have to have two different diagnoses codes to use this modifier.
How it functions: The proof is in the documentation of the E/M coding. Your dermatologist's documentation should clearly establish that the visit's purpose was not to perform the procedure. If you meet denials on modifier 25 claims simply because you use the same diagnosis code for the evaluation & management and the procedure, you should appeal taking that your dermatologist's documentation supports reporting separate services.
