How does Highmark Medicare Services review Evaluation and Management Services (E/Ms) billed with the -25 modifier?
Modifier -25 is defined as a significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service. In the review of E/M services billed with the -25 modifier, Highmark Medicare Services will first identify within the medical records the documentation specific to the procedure or service performed on that date of service. Next, we will consider the additional documentation separate from the documentation specific to the procedure or service to determine: • If there is a significant, separately identifiable E/M service that was rendered and documented, and • If the required components of the E/M service are supported as “reasonable and necessary” per Social Security Act, Section 1862(a)(1)(A), and • What level of care is supported by the documentation.
Related Questions
- When is time a factor in determining the coding level of the usual evaluation and management services (new and established patient office visits, consultations and hospital follow-ups)?
- How do I code for extended evaluation and management services where counseling and coordination does not comprise a majority of the visit?
- Can psychologists bill Evaluation and Management Codes to report these services to Medicare and private insurance plans?
