Medical Auditing Practice Exam

What should be included in an appeal for denials of E/M services performed on the same date as a minor procedure?

1. NCCI policy manual for modifier 25

2. CPT codebook

3. Revised claim forms

4. Chart documentation only

The correct answer is: NCCI policy manual for modifier 25

Including the NCCI (National Correct Coding Initiative) policy manual for modifier 25 in an appeal for denials of Evaluation and Management (E/M) services performed on the same date as a minor procedure is essential because this modifier is specifically designed to indicate that a significant, separately identifiable E/M service was provided. The NCCI policy manual provides guidelines that clarify when modifier 25 is appropriate, detailing how it distinguishes between the E/M service and the minor procedure. When E/M services and a minor procedure occur on the same day, payers require clear evidence and justification that the E/M service is not bundled into the procedure and is indeed separately identifiable. The NCCI policy manual outlines the criteria for using modifier 25 and supports the appeal with authoritative regulations. Since the appeal process often requires compliance with coding guidelines and documentation that substantiate the claim, referencing the NCCI policy manual fortifies the argument for the separate billing of E/M services associated with the minor procedure. The other options, while potentially useful, do not specifically support the appeal as effectively. The CPT codebook provides coding information but might not directly address the rationale needed for the modifier's application in the context of a denial appeal. Revised claim forms may be necessary if there were errors in the