KMA Sends Letter to Anthem Regarding Modifier 25 Change

KMA President Bruce Scott, MD sent a letter to Anthem Health Plans of Kentucky President Kennan Wethington regarding a recent change in coding policy announced by Anthem concerning the use of Modifier 25. The new policy, published in the February 2019 Anthem Kentucky Provider Newsletter, says Anthem will deny an E/M service with a modifier 25 billed on the day of a related procedure, when there is a recent service or procedure for the same or similar diagnosis on record. This change seems to create a new coding rule beyond the bounds of CPT that materially changes billing practices. KMA pointed out that the national standards that exist under CPT should be followed for consistency and that Anthem must adhere to Kentucky law in properly communicating any such a change in coding standards.  To view Doctor Scott’s letter, click here.