September 5, 2023

APMA recently created two new workgroups that emerged from discussions at APMA’s Health Policy and Practice Committee and Coding Committee annual meetings May 12–13. These workgroups have been established to address significant issues facing APMA’s membership and to further APMA’s commitment to member education.

The first workgroup was formed to address Evaluation and Management (E/M) Codes billed with minor surgical procedures and the -25 modifier. APMA established a -25 modifier workgroup in 2019 to address efforts by insurance companies, including Medicare Advantage Organizations (MAOs), to deny or reduce payments billed with the -25 modifier. APMA became aware at that time that our members may require additional understanding of the intricacies of coding related to the -25 modifier. As a reminder, the -25 modifier is used when a significant, separately identifiable evaluation and management service with no work inherent in the procedure itself by the same physician occurs on the same day of the procedure or other service. Based on that need, APMA’s workgroup developed tools and resources available at www.apma.org/25modifier. The new workgroup intends to build upon the successes of the earlier workgroup and develop additional tools and resources to supplement gaps in education that still exist for APMA’s membership. For more details and updates on the -25 modifier, visit our dedicated resource page at www.apma.org/25modifier.

The second workgroup was established to address APMA’s advocacy efforts related to Correct Coding Initiative (CCI) Edits and Medically Unlikely Edits (MUE), with a goal of identifying opportunities for additional CCI and MUE advocacy and determining what types of additional education may be beneficial for APMA members. For a refresher on CCI Edits, view a webinar produced by APMA’s Coding Committee.

Stay tuned for updates and opportunities to participate as the workgroups address these vital issues.

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