Demystifying E/M and Modifier-25: Compliance Made Easy
The Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) have identified the misuse of Modifier 25 as a significant compliance concern. Improper application of this modifier can lead to upcoding, resulting in substantial penalties. Commercial payers also scrutinize claims involving Modifier 25, as incorrect usage may indicate billing for services that are not significant or separately identifiable. Therefore, accurate application of Modifier 25 is crucial to avoid audits and ensure compliance with federal and payer-specific billing regulations. This webinar is designed to provide healthcare professionals with a comprehensive understanding of Evaluation and Management (E/M) services and the correct application of Modifier 25. This session will delve into the complexities of Modifier 25, clarifying common misconceptions and offering practical guidance to ensure accurate coding and billing practices.
Learning Objectives
Understand the criteria that constitute a “significant, separately identifiable” E/M service when performed on the same day as another procedure
Identify documentation requirements to substantiate Modifier -25
Learn the appropriate scenarios for appending Modifier 25 to E/M codes
Gain insights into the necessary documentation to substantiate the use of Modifier 25
Ensure adherence to payer policies and reducing the risk of audits
Identify frequent errors and challenges associated with Modifier 25 usage
Discover strategies to overcome documentation and coding errors
Areas Covered in the Session
Importance of E/M and Modifier 25 compliance
Understanding Modifier 25: Definition and Purpose
Evaluation and Management (E/M) Services
Defining “Significant and Separately Identifiable”
Differentiating between routine and additional services
Global Periods and Minor Procedures
Essential Documentation Practices
Avoiding common documentation pitfalls
Overview of payer-specific requirements
Frequent Errors in Modifier 25 Application
Strategies for Accurate Coding
Detailed case studies illustrating correct and incorrect Modifier 25 usage
Live Q&A Session
Suggested Attendees
Physicians
Physician Assistants
Nurse Practitioners
Certified Nurse Midwives
Medical Coders
Medical Billers
Compliance Officers
Hospital Administrators
Practice Managers
Revenue Cycle Staff
About the Presenter
Pam D’Apuzzo, CPC, ACS‑EM, ACS‑MS, CPMA, is a Managing Director at VMG Health leading the Coding, Compliance, and Operational Excellence Management service line. She is a recognized leader and industry expert in coding and compliance. Pam’s 30-plus years of healthcare consulting experience spans academic medical centers, community hospitals, faculty practice plans, and large private practices.
A trusted adviser to New York’s leading healthcare institutions, she conducts educational and training seminars and provides comprehensive compliance programs. Pam also has a successful record of practice management services including operational and billing review, practice assessment, practice start-up assistance, and EMR implementation.
Pam is a frequent speaker at conferences sponsored by the American Academy of Professional Coders (AAPC), Health Financial Management Association (HFMA), New England Healthcare Internal Auditors (NEHIA), California Health Information Society (CHIA), New York State Society of Physician Assistants (NYSSPA), Suffolk County Medical Society (SCMS), and American Association of Gynecologic Laparoscopists (AAGL).
Additional Information
System Requirement:
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to hear clearly
Live Course Cancellation Policy: If for any reason Skillacquire need to cancel this program, Skillacquire will notify participants by email of the cancellation no less than 24 hours prior to the expected start time.
For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com