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BLOG - More Modifier 25
You are most probably seeing an increase in the number of times you are receiving OCE edit 21 for a Medical visit on same day as a type “T” or “S” procedure without modifier 25. In the past, services like CXR’s, insertion of urinary catheters and removal of impacted cerumen were assigned to status indicator X. With the initiation of the expanded packaging and the deletion of status indicator X under the OPPS for CY 2015, many of these procedures were reassigned to status indicator Q1 or S. When a combination of status S (or T) and an E/M visit level are reported on the same date of service, an edit is triggered asking if modifier -25 is appropriate for the E/M visit level. This means that the combination of codes that will trigger Edit 21 has increased. Be sure to continue to review the documentation to insure that appending the modifier is appropriate.
Written by Denise Williams, RN, CPC-H Sr. VP, Revenue Integrity Services, HRAA
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