Information About Modifier 25 and Coding
Information and guidance regarding three extremely active payment and compliance issues:
1. Audit requests regarding OMT services reported on the same date of service as an office visit, along with the use of the Modifier-25.
2. Audit requests related to coding higher level Evaluation and Management (E/M) services; often linked to the increase in use of electronic health records, and;
3. Pay-for-performance and other quality recognition programs requirements for physicians to justify any practices that may cause them to be considered practice (cost) outliers.
AOA Letter regarding audits and Modifier 25 - http://files.academyofosteopathy.org/OME/AOA_Modifier25Usage-AuditsLetterOct23-2012.pdf
AOA Position Paper on Evaluation and Management Services with OMT
revised July 2006
CMS-Trailblazer audit tool – http://files.academyofosteopathy.org/OME/AuditWorksheetCMS-Trailblazer.pdf
Medicare-Modifier 25 Use – http://files.academyofosteopathy.org/OME/MedicareModifier25Use.pdf
November 2011 Federal Register pages – http://files.academyofosteopathy.org/OME/FedRegister2011OMTpages.pdf
Coding Trends of Medicare Evaluation and Management Services
US Department of Health & Human Services
Office of Inspector General report (OEI-04-10-00180)