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What to know when billing modifier -25 — 3 key pointers

Several commercial payers have adopted stricter reimbursement policies to deny modifier -25 claims upfront, according to Joette Derricks, a healthcare compliance and revenue integrity consultant who spoke to Medical Economics.

Medical Economics outlined three tips for avoiding denials related to modifier -25:

1. Apply the modifier to the evaluation and management code, rather than the code for the procedure.

2. Document why the additional E/M service was necessary.

3. Be cautious about using the modifier for pre-scheduled and repetitive procedures, such as skin tag removals or pain injections.

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