General Question for the Week of August 8, 2016

General Compliance Question of the Week

Question:

What documentation is needed to support the need for modifier -25 for evaluation and management (E&M) services?

Answer:

Both the medically necessary E&M service and the procedure must be appropriately and sufficiently documented by the physician or qualified non-physician practitioner (NPP) in the patient’s medical record to support the need for modifier -25 on the claim for these services, even though the documentation is not required to be submitted with the claim. For more on this, go to http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM5025.pdf.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.