Understanding the "25" Modifier
The “25” modifier has changed drastically in the last couple of years!! Let us review it carefully!
Join expert speaker, Duane Abbey, as he simplifies the usage of “25” modifier, and how to:
- Carefully review the definition of the “-25” modifier in the context of E/M coding.
- Understand how this modifier has changed over the years.
- Appreciate the physician use of the “-25” modifier.
- Understand the use of the “-25” modifier for APCs.
- Review the OIG findings for physician use of the “-25” modifier.
- Review CMS guidance relative to the “25” modifier.
- Appreciate the compliance issues surrounding hospital use of the “-25” modifier.
- Review the findings of DOJ studies on hospital use of the “-25” modifier.
- Discuss the difference between ‘unrelated’ and ‘separate’ services relative to the “-25” modifier.
- Appreciate possible RAC activities with the “-25” modifier.
I. Overview of E/M Coding.
- Types of E/M Levels.
- Physician Utilization.
- Hospital Utilization.
- Global Surgical Package Concept for Physicians.
- Surgical Package Concept for Hospitals
II. The “-25” Modifier.
- Definition and Description in CPT.
- Physician Interpretation.
- Hospital Interpretation.
- Changes in the Definition Over the Years
III. Key Definitional Issues
- Unrelated Services – Separate Diagnoses.
- Separate, Significantly Identifiable Services.
- Documentation Issues
IV. Compliance Issues.
- Physician Utilization of the “-25” Modifier.
- OIG Report.
- Hospital Utilization of the “-25” Modifier.
- DOJ Studies .
- Audit Guidelines.
- CMS Guidance.
- Possible RAC Involvement.
- OIG Study Findings
V. Case Studies
VI. Sources for Further Information
Who should attend? Coding Personnel, Billing and Claims Transaction Personnel, Chargemaster Coordinators, Financial Analysts, Compliance Personnel, Physicians and Other Interested Personnel
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About Our Speaker
Duane C. Abbey, Ph.D., is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in health care consulting and related areas. Abbey earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years experience as a consultant. He performs various financial analysis, including business structuring, organizational development, enrollment, and other financially related concerns of an organization. Abbey's consulting...
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- Save money on travel.
- Meet your specific training needs.
- Keep learning after the event.
- Save time training your whole staff.