Author Topic: MODIFIER 25  (Read 1012 times)

ellie

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MODIFIER 25
« on: August 18, 2013, 02:48:23 PM »
   ANYONE HEARD OF MEDICARE REJECTING OFFICE VISIT WITH 25 WITH INJECTIONS FOR ONE DIAGNOSIS ?

dermbillerPA

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Re: MODIFIER 25
« Reply #1 on: August 23, 2013, 12:44:47 PM »
Most likely this is due to the latest version of the NCCI edits, which now bundles minor office procedures with established office visits.  There must be a separate identifiable E/M service documented.  This has always been the rule with mod 25, but CMS is cracking down and strengthening the rule.  You can override the edit by using modifier 59 along with the 25 if indeed there is documentation.  However, I would be cautious with only one diagnosis pertaining to the procedure.