Tag: Modifier 25

Endoscopy billing

Don’t Make These Mistakes When Billing for Endoscopy Services

In the complex world of medical billing, few specialties present as many coding challenges as gastroenterology. Endoscopy billing—covering a wide range of procedures from colonoscopies to upper GI endoscopies—is a cornerstone of diagnostic and therapeutic care. However, the intricate rules governing their billing can be a minefield for healthcare providers and billing professionals. A single […]
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claim denials with chiropractic

Preventing Denied E&M Claims with Chiropractic Manipulative Therapy (CMT)

The observed an increasing number of denied Evaluation and Management (E&M) claims (99201-99215) when billed concurrently with chiropractic manipulation procedures, including chiropractic manipulative therapy (CMT), highlighting the potential for increased claim denials with Chiropractic Manipulative Therapy (CMT). Denial Reasons & Misconceptions: Common denial reasons include: “Service billed is included in another procedure billed the same […]
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Acupuncture CPT Codes

Master Acupuncture CPT Codes: Improve Billing & Reimbursement

Acupuncture is a time-honored practice that has gained recognition in modern healthcare systems worldwide. However, for acupuncture providers, navigating the intricate world of Current Procedural Terminology (CPT) codes can be challenging. Accurate coding of acupuncture CPT codes is essential for reimbursement, compliance, and seamless claim processing. This guide dives deep into the nuances of acupuncture […]
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Understanding Modifier 25: A Comprehensive Guide

Understanding Modifier 25: A Comprehensive Guide

Often, a seemingly routine preventive visit or minor surgery can take an unexpected turn when a patient mentions a new concern, such as “Oh, by the way…” If a physician provides additional care beyond the originally scheduled service, you may be able to bill for a separate evaluation and management (E/M) service using modifier 25. […]
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Modifier 25: Essential Tips for Accurate Billing and Compliance

Modifier 25: Essential Tips for Accurate Billing and Compliance

Description: 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. Navigating the Challenges of Modifier 25 in Healthcare Billing Modifier 25 healthcare billing in continues to be a source of frustration for healthcare providers. Health […]
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How to Bill an E/M With a Minor Procedure

To determine the appropriate use of modifier 25, review this case study in otolaryngology. The Cigna Group has delayed the requirement for submitting documentation with claims that involve a 25 modified offices or other outpatient evaluation and management (E/M) service (CPT® 99212-99215) and a minor procedure. Despite the payer not enforcing this requirement, physician practices […]
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Using Modifier – 25 on an E_M Visit

Using Modifier – 25 on an E/M Visit

In recent years, there has been an increase in scrutiny regarding the use of modifier -25 to identify separate evaluation and management (E/M) services on the same day as another procedure. Insurers are now demanding documentation of such services both before and after payment, leading to a significant administrative burden for urology practices. The reason […]
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CPT Modifiers for Physicians to Get Paid

CPT Modifiers for Physicians to Get Paid

During a typical office visit, physicians may provide evaluation and management (E/M) services, minor procedures and more. The question is: Can they bill for each one separately? In some cases, the answer is no. In others, though, the answer is yes — but they must know what current procedural terminology (CPT) modifier to append. Modifiers […]
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Can you bill E_M from the same appointment

Can you bill E/M from the same appointment?

Despite myths to the contrary, physicians are not prohibited from coding and billing for both preventive and problem-focused evaluation and management (E/M) services when they are performed during the same appointment. Motivated by a desire to avoid audits, many physicians tend to undercode for the work they perform. Others, however, are just unaware that the idea that […]
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