Issues With Modifier 25


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Recently, I wrote a letter to the American Medical Association (and copied multiple Oncology-related professional organizations) requesting that they eliminate the coding rule to append the Modifier 25 to the oncology office visit and office procedures when two services are offered to cancer patients the same day.

This letter had 46 pages of back-up documentation to support my request. This is an important letter/document as it includes regulations as well as AMA and historical Federal Register citations proving that the evaluation is required on 90% of the Oncology infusion patients. In my opinion, the Modifier 25 is the biggest threat to private practice Oncologists attempting to help their patients by offering the infusions and procedures on the day of an evaluation.

Too many practices are becoming targets of inappropriate audits. My letter and the supporting documents will hopefully shed light on this foolishness, however, I am certain this request to eliminate the Modifier 25 will require some lobbying and support of the Oncology community.

In upcoming blogs, I will dissect this issue a little at a time.

~ Best

Marty Neltner

#modifier25 #oncology

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