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Using Modifier 25 in Otolaryngology: Rewards and Ramifications
Appending modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to an Evaluation and Management (E/M) code, when also billing a minor procedure on the same day, typically results in payment for both services – the reward. But is it correct?
Payors, including the Office of the Inspector General (OIG), have been auditing the proper use of modifier 25 and recouping millions of dollars from otolaryngologists – the ramification. A common misconception is that the E/M code and procedure code are always billed together. That’s just not true. There are times when it is not appropriate to also report the E/M code but bill only the procedure.
Please note: CEUs expire on 3/31/2023
E/M Coding & Office Procedure Coding
- Demonstrate comprehension of the difference between the 2020 E/M documentation requirements compared to the revised 2021 E/M documentation requirements.
- Demonstrate understanding of when to report consultation codes instead of other E/M codes to increase reimbursement when applicable.
- Report E/M services with modifier 25 compliantly.
- Distinguish the difference between the diagnostic endoscopy codes 31231, 31575 and 92511.
- Describe the documentation requirements for using the cerumen removal code, 69210, and when an E/M code may be separately reported.
- Apply E/M modifiers accurately.
- Describe the telehealth guidelines changes allowed during the public health emergency
- Identify key requirements for “incident to”, direct and shared/split billing non-physician practitioners (NPPs)
Please Note: CEUs expire on 11/30/2022
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