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.