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Using Modifier 25 in Otolaryngology: Rewards and Ramifications 2023

Using Modifier 25 in Otolaryngology: Rewards and Ramifications 

Total Runtime: 1 hour and 36 minutes

Appending modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to an Evaluation and Management (E/M) code, when also billing a minor procedure on the same day, typically results in payment for both services – the reward.  But is it correct?

Payors, including the Office of the Inspector General (OIG), have been auditing the proper use of modifier 25 and recouping millions of dollars from otolaryngologists – the ramification.  A common misconception is that the E/M code and procedure code are always billed together.  That’s just not true.  There are times when it is not appropriate to also report the E/M code but bill only the procedure.

We will examine the CPT guidelines about using modifier 25 as well as what Medicare says.  Several scenarios frequently encountered in otolaryngology practices will be reviewed.  You will have a better understanding of how to correctly use modifier 25 when performed with the common ENT minor procedures including:

  • Nasal endoscopy
  • Flexible laryngoscopy
  • Endoscopic sinus debridement
  • Excision of skin lesion, and
  • Cerumen removal

**Note: CEU credits expire on 4/30/24 for this course. 

  • Using Modifier 25 in Otolaryngology: Rewards and Ramifications (2023)
    Includes Credits
    Component Credit Type State/Medical Type Available Credits Earned Credits
    CEU Certificate Medical CEU 1.50 0.00
    Recorded On: 04/12/2023

    $199 | Appending modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to an Evaluation and Management (E/M) code, when also billing a minor procedure on the same day, typically results in payment for both services – the reward. But is it correct?

    Using Modifier 25 in Otolaryngology: Rewards and Ramifications 

    Total: $199

    Appending modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to an Evaluation and Management (E/M) code, when also billing a minor procedure on the same day, typically results in payment for both services – the reward.  But is it correct?

    Payors, including the Office of the Inspector General (OIG), have been auditing the proper use of modifier 25 and recouping millions of dollars from otolaryngologists – the ramification.  A common misconception is that the E/M code and procedure code are always billed together.  That’s just not true.  There are times when it is not appropriate to also report the E/M code but bill only the procedure.

    Learning Objectives

    We will review:

    • CPT and Medicare guidelines for applying Modifier 25.
    • Real scenarios frequently encountered in otolaryngology practices.
    • When it is and is not appropriate to bill E/M and procedure codes.

    You will gain a better understanding of how to correctly use Modifier 25 with common ENT minor procedures including:

    • Nasal endoscopy
    • Flexible laryngoscopy
    • Endoscopic sinus debridement
    • Excision of skin lesion
    • Cerumen removal

     

    Reminder: You have 30 days to complete the course from the day you open and access the course. 

    **Note: CEU credits expire on 4/30/24 for this course. 

    Deborah Grider, CDIP, CCS-P, CPC, CPC-I, CPC-P, COC, CEMC, CPMA.

    Consultant and Speaker

    Deborah is a nationally sought after leader in the industry and is passionate about assisting physicians and hospitals in improving their coding, documentation, and business operations to maintain compliance and improve revenue. She will go above and beyond to help industry leaders, physicians and others achieve excellence.

    Find out about more about Deborah Grider, CDIP, CCS-P, CPC, CPC-I, CPC-P, COC, CEMC, CPMA.

    AAPC Accreditation 

    This program meets AAPC guidelines for 1.5 CEUs. Can be split between Core A, CEMC and CPMA after successful completion of a Post-Test for continuing education units. 

    Accreditation expiration date: 4/30/2024

    Important Note: Please be sure to complete the course before the CEU expiration date if you plan to obtain CEU credits.

    Course Access and Expiration

    You have 30 days to complete this course from the day you first access the content. After 30 days your access will expire. 

    Should you have questions, please contact us at education@karenzupko.com  


    Registering Multiple Attendees 

    1. Create, or have each attendee create, a user account here. 
      1. If one person is creating all of the accounts you will need to log out each time to create the next account.
    2. Log in with the account that you wish to pay through and add desired products to your cart. 
    3. Once you have selected all the desired products, go to your cart. 
      1. You will initially be registered for each product. You can edit this after you have added the additional attendees using the "remove" button.
    4. To add the additional attendees select the green button in your cart titled “Add a Registration for Another User.”
    5. Enter the email address for the additional attendee.  If they have an account their name will populate and you can select “Add Product for This User.”
    6. The attendee's name will appear in the registrant column under your own. 
    7. Repeat this for each additional attendee.
    8. Proceed, filling out the additional information for each attendee and completing payment.

    If you have any issues with completing your registration please email us at education@karenzupko.com or call 312 642-8310 

Course Access and Expiration

You will have access to this package for 30 days from the day you purchase it.

You will have 30 days to complete the course(s) within the package. 

The 30 days for a course starts the day you activate that course within the package.

Should you have questions, please contact us at education@karenzupko.com  

This course includes a digital workbook. This workbook is copyrighted and not to be shared with anyone other than the registrant for this course.

No physical workbook is available for this course. 

If you have any questions please email education@karenzupko.com 

What are some of the benefits of registering with KZA On-Demand?

  • View at YOUR convenience—the course is online and authored by experts in the field
  • Receive a printed, comprehensive workbook. Our workbooks are considered the gold standard in reference material
  • Accredited for CME and CEUs
  • You have 30-day access to the individual course(s)

Registering Multiple Attendees 

  1. Create, or have each attendee create, a user account here. 
    1. If one person is creating all of the accounts you will need to log out each time to create the next account.
  2. Log in with the account that you wish to pay through and add desired products to your cart. 
  3. Once you have selected all the desired products, go to your cart. 
    1. You will initially be registered for each product. You can edit this after you have added the additional attendees using the "remove" button.
  4. To add the additional attendees select the green button in your cart titled “Add a Registration for Another User.”
  5. Enter the email address for the additional attendee.  If they have an account their name will populate and you can select “Add Product for This User.”
  6. The attendee's name will appear in the registrant column under your own. 
  7. Repeat this for each additional attendee.
  8. Proceed, filling out the additional information for each attendee and completing payment.

If you have any issues with completing your registration please email us at education@karenzupko.com or call 312 642-8310