As a reminder to our Practicefirst clients, please review the
description, definition and proper usage of modifier 25 as
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.