• Vidya Baliga

Modifier 25

Modifier 25

As a reminder to our Practicefirst clients, please review the

description, definition and proper usage of modifier 25 as

stated below:

Description: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service.

Definition (As per CPT):

A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported. The E/M

service may be prompted by the symptom or condition for which

the procedure and/or service was provided. As such, different

diagnoses are not required for reporting of the E/M services on

the same date. This circumstance may be reported by adding

modifier 25 to the appropriate level of E/M service.

Points to remember:

  • Modifier 25 can only be added to the E&M and not the procedure.

  • There is a certain amount of evaluation and management work inherent to each procedure. The usage of modifier 25 is only justified when E&M documentation supports there has been a significant amount of additional work above and beyond, what the physician would normally provide.

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