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Avoid Claim Denials for Procedures and E/M Services – Performed on SAME Day
Posted on: 4/9/2018

Getting nowhere on reimbursements for certain services delivered during the same encounter?

For example, say your patient came in for a minor/office-based procedure. And on that same day, the patient's condition required a completely separate evaluation and management (E/M) service, beyond the preoperative or post-operative care usually associated with that procedure.

The Centers for Medicare and Medicaid Services and other insurers may deny claims for these services – even if the services were appropriately performed. 

Learn how to avert these claim snafus with ISMS' new Issue Brief, Modifier -25*. This resource covers how to properly code and document separate E/M services delivered during the same encounter as a minor procedure. In many cases, these claims are billable and payable by third party payers.

If you need assistance resolving these claim hassles, ISMS members and their practice management professionals may also contact our advocacy team with questions by calling 800-782-4767 ext. 1470, or by sending an email.


As a member benefit, this Issue Brief is password protected.

If you need to request a username and password, contact online support at 888-476-7776 or onlinehelp@isms.org between 8:30 a.m. and 4:45 p.m. After-hours requests are answered promptly the next business day. You may also register online or retrieve your username or password.

*This CPT® modifier is defined as a significant, separately identifiable service by the same physician or other qualified health care professional on the same day as a procedure or other service. 



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