Coding Tip - Modifier-25

Amy Shilliam, CPC

Modifier-25 is used to identify a significant, separately identifiable E/M (Evaluation and Management) service performed by the same physician on the same day as another procedure or other service.

Guidelines:

  1. Modifier-25 is used to indicate that on the day of a procedure, the patient's condition required a significant, separately identifiable E/M service that was above and beyond the procedure/other service.

  2. If a decision was made for a major surgical procedure (those with a 90 day global period), the modifier-57 should be used.

  3. When the patient is being seen for multiple conditions, be sure to attach the correct diagnosis for the separate E/M visit.

  4. When billing an E/M with a modifier-25, the key elements must be documented (history, examination and decision making).

  5. It is appropriate to use modifier-25 on E/M services codes.

  6. Use modifier-25 on critical care (99291-99292) visits during the global surgical period. This will indicate that the visits are significantly and separately identifiable from the procedure(s)/other service.

  7. Modifier-25 can be used on the emergency department code when the E/M is separately identifiable and documented.