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.