Have you ever imagined that more than 30% of claims denials are tied to the wrong coding? All of these statistics showcase the accuracy in billing by modifiers. If not used correctly, these small codes can affect the reimbursement process. Therefore, if you are a healthcare professional, medical biller, or coding specialist, this guide is for you. Keep reading about the Modifier 24 & 25 descriptions, and exclusive tips to enhance their proper usage.
What is Modifier 24?
Modifier 24 has no connection to the management and evaluation services by the same physician at the same day. The use of modifier 24 is helpful when patients need management and evaluation services other than postoperative surgery.
Examples of modifier 24 in action:
Consider a situation where a patient has undergone knee surgery but returns during the postoperative period having symptoms of the flu. Treatment and evaluation of such patients are not linked to the surgical processes. So, in such situations, you can implement modifier 24 to the right E/M service code.
General mistakes with modifier 24:
Lack of documentation:
Always make sure that the notes can explain that the service has no relation to the process.
Using modifier 24 for related services:
There is no need to apply this modifier when the visit is associated with the surgery.
Omitting Operative Details:
The surgical method should need to be explained to demonstrate the distinction of services.
To prevent denials, the attachment of modifier 24 description with robust documentation could be beneficial.
What is Modifier 25?
Modifier 25 can be described as “significant, identifiable management and evaluation service by the same physician on the same day of service or procedure.” Moreover, this modifier helps the additional E/M service perform alongside a process.
Example of modifier 25 in action:
The example of modifier 25 could he related to a patient who schedules an injection for chronic back pain. During the visit, the patient discussed mental health and required separate counseling. In this case, the counseling session would be documented as a different E/M service, so you can append CPT modifier 25 to the E/M code.
Common Mistakes with Modifier 25:
Considering all E/am services:
Looking for the condition where a patient, before a scheduled minor procedure, doesn’t justify the modifier 25 description.
Under justify complexity:
You should keep in mind that not all the same-day services will qualify. Thus, your notes should elaborate on the importance of additional service.
Having a detailed look at the documentation about what is Modifier 25 scenario will ensure claim denials and precise billing.
Differences Between Modifier 24 & 25:
| Modifier | When to Use | Key Factor | Example |
| Modifier 24 | During postoperative care for unrelated E/M services | Unrelated to surgery | Treating the flu during the postoperative knee surgery period |
| Modifier 25 | On the same day as a procedure for separate E/M services | Significant and separate service needed | Counseling is provided in addition to a scheduled injection |
Can we Bill Modifier 24 and 25 together?
If you want to know, can you bill both modifiers together, the answer is yes. There are different situations where using modifier 24 and modifier 25 on the same claim is reasonable. But it needs robust documentation and precise sequencing.
Guidelines for Billing
Modifier 24 and 25 Together:
The use of modifier 24 is appropriate when the evaluation is not related to surgery and occurs in the postoperative period. Detailed and clear notes will make sure your claims avoid denials when combining modifiers. If you want to know, we can bill modifier 24 and modifier 25 together, you can do but you should consider the precision.
Best Practices for using Modifier 24 and Modifier 25
The compliance and reduced denials could be ensured by proper documentation. The following are some of the best practices that are recommended by experts:
Train your Team:
Educate your billing and coding staff regularly about the CPT modifier 25 and 24 modifiers in medical billing.
Audit Periodically:
Try to conduct audits for precise modifier use and review claims.
Streamline Documentation:
Ensure that E/M service is documented clearly to justify the use of modifier 25 or modifier 24.
Use technology:
Make use of billing software that provides context for choosing codes.
Stay Compliant:
Stay updated with the rules and regulations of payers because modifier guidelines can vary slightly among insurers.
FAQs about modifier 24 and modifier 25:
Q1. Can modifier 25 be used for same-day process consultation?
The answer is no because it requires E/M service that can be identified separately and significantly.
Q2. What documents are required for modifier 24?
For the documentation, you need detailed notes that outline how E/M service is not related to procedures and surgery performed.
Q3: Why do insurance companies not accept modifier 25 claims?
Denials can take place because of less documentation or when it is not clear whether E/M service was unique and significant.
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