Modifier -25: OIG watches, Payers may not pay - Providers don't know what to do!  

When the Office of the Inspector General (OIG) comes out with its report on what issues it has concerning the Medicare program, everybody is eager to read it. Payers (Medicare carriers in particular) want to know if they are appropriately processing claims. Physicians and Suppliers want to know how they might improve their documentation to better illustrate the actual services being rendered. And the consultants, coders, billers, and managers are looking at it to see what they should be targeting regarding audits, education, and needed updates.

Modifier -25, as defined in CPT®, reads: "Significant, Separately Identifiable Evaluation and Management (E/M) Service by the Same Physician on the Same Day of the Procedure or Other Service." This modifier has been on the OIG's watch list for a number of years. The provider community is appending modifier 25 to E/M services when a proced...