CMS & AMA Guidelines for Modifier 25: Coding, Billing and Reimbursement

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Course Description

There are several modifiers for billing and coding and modifier 25 is one of those that are controversial and used inappropriately. When used inappropriately there is a risk that an audit of these claims may result in refunds and penalties. This session will focus on when a modifier 25 can be used and what to look for in determining if the documentation supports a separately and significantly identifiable. This session will also review the CMS and AMA current rules and guidelines related to Modifier 25.

Learning Objectives

• The real description of Modifier 25
• Know the rules and guidelines related to Modifier 25
• The proper CPT codes that modifier 25 can be used with
• What does Medicare say regarding modifier 25
• Supporting documents for Modifiers
• Avoid utilizing modifier 25 in error

Areas Covered in the Session

• Modifier 25 Overview
• AMA guidelines and examples of the use of modifier 25
• CMS guidelines and examples of the use of modifier 25
• Chapter 12 30.6.6.B
• Documentation to support the use of Modifier 25
• 2023 NCCI Policy Manual- Chapter 1 page 17
• How does modifier 25 affect NCCI edits
• NCCI Policy Manual Example
• Minor Surgery Example
• Modifier 25 Reimbursement Guidelines
• Similar modifiers to 25
• Commercial insurance policies that have been rescinded
• What are the procedures that correspond with modifier 25?
• 2023 CPT® Changes
• Coding Tip and Instructions for Use of the CPT® Codebook
• CPT® E/M Guidelines
• Modifier 25 - Yes or No?
• Horizon BCBS NJ
• Use of Modifier 25
• Appeal Example – Visit and Injection
• Recent Cases and example

Suggested Attendees

• Billers
• Coders
• Administrators
• Managers
• Supervisors
• Physician
• Non-Physician Providers
• Qualified Healthcare Professionals
• Compliance Officers
• Consultants
• Claims Adjusters
• Case Managers
• Clinic Managers
• Insurance Company Claims Reviewers

About the Presenter

Lynn M. Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC is the Sr. Coding Educator for Healthcare Information Services, a revenue cycle management and consulting service in the Chicagoland area. Prior to relocating to Chicago, Lynn was the Billing Office Manager and surgical coder for Hand Surgery Associates, now Michigan Surgery Specialists in the Detroit Area. She has over 39 years of experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Her experience is primarily in the specialties of Orthopaedics, Rheumatology, and Hematology/ Oncology. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, Audio Conferences, Certification classes, and Webinars. Lynn became a CPC in 1993, a Certified Instructor in 2002, and a Certified Orthopedic Surgery Coder in 2009, an examination in which she participated in creating. She passed the Certified Practice Manager exam in 2015, the Certified Medical Auditor exam in 2016, and the Certified Professional Biller exam in 2021. Lynn is the founder of the first local chapter of the AAPC in Chicago, which is now 25 years old, and a former member of the AAPC National Advisory Board as well as several other committees for the AAPC. 

Additional Information

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com 

This is a Live Virtual session.

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