Urology Coding and Reimbursement Podcast
Urology Coding and Reimbursement Podcast
✓

UCR 101: Modifier 25 - deep dive

00:56:22
Podcasts
RSS
Link

이 에피소드에 관해

June 24, 2022

Mark and Scott welcome Dr. John Lin to the podcast to discuss in detail Modifier -25.

Skyline Urology to Pay 1.85M to Settle False Claims Act Allegations of Medicare Overbilling 

https://www.justice.gov/opa/pr/skyline-urology-pay-185-million-settle-false-claims-act-allegations-medicare-overbilling 

Also Corporate Integrity Agreement 

OIG Audit Modifier 25

https://oig.hhs.gov/oei/reports/oei-07-03-00470.pdf

 

NCCI Policy Manual: https://www.cms.gov/medicare/national-correct-coding-initiative-edits/ncci-policy-manual-medicare 

Chapter 7: GU System

The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. 

Cigna:  

https://www.cmadocs.org/newsroom/news/view/ArticleId/49780/Cigna-to-require-medical-records-for-all-modifier-25-claims
Cigna’s Modifier Policies: https://static.cigna.com/assets/chcp/resourceLibrary/clinicalReimbursementPayment/medicalClinicalModifiersPolicies.html


Cigna’s Modifier 25 Policies:
https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifiers/Notifications/Modifier_25_Significant_Separately_Identifiable_Evaluation_and_Management.pdf 

 

Horizon BCBS: Beginning on August 1, 2022

https://www.horizonblue.com/providers/news/news-legal-notices/claim-reimbursement-update-e-m-codes-appended-modifier-25 

 

BCBS of Massachusetts: Effective July 18, 2022, 


https://provider.bluecrossma.com/ProviderHome/portal/home/news/news/claims-coding-payment/all%20networks/!ut/p/z0/rZBNb8IwDIb_Sjj0OMUU6ODYsbVl0E1oApVcJtMGyEiTkkZl_PulaEP70G4c4_eJ_diU0YwyhY3YohVaoXTvFQteE38y7k6H8BwHywjms_5o6N8uAOYBfaTMAcswSO6ixIdhGkUwefLjcBHFPRj12w7i7XBgIWW5Vpa_W5pVRjei4IZU2liU5BwoS6RYGzQnDy5A7soGpavs0JSYu0wbFwi1JSUvRH4WrT0oUUhSc9OInJMv-NPuog8T_x7mD93kpRdNexAH17KrLaoCpVbcAzT5TjS8IIof63aAb9JxuqWsQru7EWqjafaT-WX598j_NJHS_bdHbfb1tRZpfTzIJYqydnzR3rnCU-lyt9n3gdWerQeymW1SO1iFnc4H0ChcIg!!/ 

건강 및 피트니스
영어
미국
API를 사용하여JSON에서 이 에피소드를 가져옵니다.

이 에피소드 내

이 태그 수정하기

전사 🔗

Are you the producer of this podcast? Add a podcast transcript
Need Audio-to-Text? Transcribe with Listen411 in Just 60 Seconds

과거 에피소드 검색

Urology Coding and Reimbursement Podcast의 과거 에피소드를 검색하세요.
이 검색 창을 웹 사이트에 삽입

이 팟캐스트의 다른 에피소드

UCR 295: New Kidney Stone Scope and Sheath Facility Payments – What Every Urologist Needs to Know

UCR 295: New Kidney Stone Scope and Sheath Facility Payments – What Every Urologist Needs to Know

· 전사
July 10, 2026 In this episode, Scott, Mark, and Dr. Ray Painter break down CMS’s latest updates to facility reimbursement for kidney stone procedures, including the revised C9761 code, the new C8014 code, and the payment implications for hospitals and ambulatory surgery centers. The discussion expl…
00:40:09
공유하기
저장하기
UCR 299: Listener Questions Answered — Billing for Radiological Services with Office Visits, Stone Diagnosis Coding, and Modifier 25 Denials

UCR 299: Listener Questions Answered — Billing for Radiological Services with Office Visits, Stone Diagnosis Coding, and Modifier 25 Denials

· 전사
August 7, 2026 In this episode, Scott, Mark, and Dr. Ray Painter answer three reimbursement questions involving common—but increasingly scrutinized—coding situations. First, they discuss when a urologist can separately bill the professional component of a radiologic service such as retrograde urogr…
00:30:01
공유하기
저장하기
UCR 298: Listener Questions Answered — Floor Consults Leading to Surgery, Pelvic Lymphadenectomy Denials, and Bladder Stone Removal During Simple Prostatectomy

UCR 298: Listener Questions Answered — Floor Consults Leading to Surgery, Pelvic Lymphadenectomy Denials, and Bladder Stone Removal During Simple Prostatectomy

· 전사
July 31, 2026 In this episode, Scott, Mark, and Dr. Ray Painter answer three detailed listener questions. First, they discuss whether an E/M service can be billed when a urologist evaluates a patient on the hospital floor and then decides to take the patient to the operating room for stone treatmen…
00:34:43
공유하기
저장하기
UCR 297: UTI PCR Coding Changes, Audit Risk, and the 2027 RVU Winners and Losers

UCR 297: UTI PCR Coding Changes, Audit Risk, and the 2027 RVU Winners and Losers

· 전사
July 24, 2026 In this episode, Scott, Mark, and Dr. Ray Painter examine a major shift in Medicare’s approach to coding UTI PCR testing. The discussion explains why reimbursement may now depend on the number of testing kits, methodologies, or procedures used—not simply the number of organisms report…
00:35:41
공유하기
저장하기
UCR 296: 2027 Medicare Proposed Rule – The Changes That Matter Most to Urology

UCR 296: 2027 Medicare Proposed Rule – The Changes That Matter Most to Urology

· 전사
July 17, 2026 In this episode, Scott and Mark Painter provide their initial analysis of CMS's proposed 2027 Medicare Physician Fee Schedule and highlight the changes most likely to impact urology practices. The discussion covers the proposed conversion factor reduction, a significant new propo…
00:37:07
공유하기
저장하기
면책 조항: 이 페이지에 포함된 팟캐스트와 작품은 Mark Painter, Scott Painter and Dr. Ray Painter에서 가져온 것입니다. 이 팟캐스트는 소유자의 재산이며 Listen Notes, Inc.와 제휴하거나 보증하지 않습니다.
PROMOTED
Listen411.com: Lightning-fast Podcast Transcription and Summarization. Transcribe 1-hour audio in under 1 minute. Pay-as-you-go.
Listen411.com: Lightning-fast Podcast Transcription and Summarization. Transcribe 1-hour audio in under 1 minute. Pay-as-you-go.
Audio to Text

추천
API를 사용하여 이 에피소드 가져오기