Redefinitions Increase the Use of Modifier 25 – Review of Ophthalmology

The redefinitions of some surgeries from major to minor procedures has led to an increase in the use of modifier 25.

This article answers the following questions:

  • What is the definition of modifier 25?
  • What types of procedures require the use of modifier 25?
  • If the physician makes the decision to perform a minor procedure on the same day as the office visit, does modifier 25 apply to that visit?
  • If the patient has two different diagnoses being addressed, is it appropriate to bill the office visit with modifier 25?
  • If only one diagnosis exists, how do we determine when to bill the visit as well as the procedure?
  • When is it inappropriate to use modifier 25 to file separately for the exam and the procedure?
  • Why are payers interested in modifier 25?
  • Are the Recovery Audit Contractors (RAC) interested in this issue?
  • How frequently do ophthalmologists use modifier 25?
  • Is there a particular reason for the increased utilization of modifier 25?

This article was published in Review of Ophthalmology’s Medicare Q & A column, which is written by Corcoran’s Vice-President, Donna McCune, CCS-P, COE, CPMA. To view the entire article in Review of Ophthalmology, click on the link below:

See page 18.

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