To view the results of the RAC audit
survey, visit
http://downloads.frankco
hengroup.com/download.html.
If you need more in-depth training
on modifier use after viewing the we- binar, contact TMA Practice Consulting at (800) 523-8766 or email
practice.con
sulting@texmed.org. Having trouble ap- pealing a claim dealing with modifier 25
OvXrayerreads for $8
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Direct your inquiries to:
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T5469.Xray Overheads
Ads.indd 1 Unraveling modifier 25
When UnitedHealthcare (UHC) re- searched its appealed claims, it found the absence of modifier 25 from the ini- tial claim frequently was the reason the claim was denied. And Texas emerged as the No. 1 state in appealed claims due to the missing modifier 25. TMA regularly receives calls, emails, and Hassle Factor Logs related to modi- fier 25. The association has teamed up with UHC and the American Medi- cal Association to offer a free webinar on using modifier 25 correctly. The 38-minute, archived presentation ap- plies to all payers, not just UHC. A sec- ond webinar on modifier 59 will follow. To register for the modifier 25 webi-
8/4/11 4:25 PM
nar, visit
https://cc.readytalk.com/cc/ playback/
Playback.do?id=9ohas8. Here are a few reminders about us-
ing modifier 25 (significant, separately identifiable evaluation and manage- ment [E&M] service by the same physi- cian on the same day of the procedure or other service):
• Use modifier 25 with E&M codes only.
• Modifier 25 is not restricted to a spe- cific level of E&M service.
• Do not use modifier 25 to report an E&M service that results in a deci- sion to perform a major (e.g., 90-day global period) surgery.
• You may use modifier 25 to report a problem-oriented E&M service you provide on the same day as a pre- ventive-medicine E&M service.
• The E&M service may be prompted by the symptom or condition for which you performed the other ser- vice or procedure. Different diagno- ses are not required for reporting the service or procedure and the E&M service on the same date.
28 TEXAS MEDICINE September 2011
— or any other reason? Report your prob- lem to the TMA Hassle Factor Log, www
.texmed.org/Template.aspx?id=230, and TMA will help you resolve it.
Physicians can report EHR, vendor issues
Have you had problems with your elec- tronic health record (EHR) system or the vendor? Are you concerned your pa- tients’ safety may be affected? The EHR Support Center, http://ehrsupport.cen
treastrec.org/#/report_options, collects data related to the potential or identi- fied patient safety and usability issues of EHR products and documents. The Texas A&M Health Science
Center Rural and Community Health Institute has partnered with the PDR Network to give physicians an opportu- nity to report EHR-related patient safety events. Both are accredited patient safe- ty organizations that seek to improve the quality and safety of health care. Data are entered into a protected data- base and used for research to find weak points in health care delivery. EHR issues you may want to report
include problems with product appli- cations, vendor-related difficulties, or contractual issues that resulted in a less-than-optimal or undesired outcome. The tool also enables physicians to re- port features of EHRs they feel are best practices. Collection of the data will help improve patient safety and quality as physicians adopt, implement, and use EHRs. n
Crystal Conde is associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email at
crystal.conde@
texmed.org.
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