What is modifier 25?

Modifier 25 Description

 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service

This is among the most common coding mistakes, costing medical practices millions each year in missed reimbursement opportunities and costing insurers millions each year in improper payments. This modifier, if inappropriately or overly utilized, leaves your practice open to audit risk.

How can we be sure we are staying compliant?

1. Modifier 25 should always be attached to the E/M code. If provided with a preventive medicine visit, it should be attached to the established office E/M code (99211–99215).
2. The separately billed E/M service must meet documentation requirements for the code level selected and must be identifiable in record. It will sometimes be based on time spent counseling and coordinating care for chronic problems.
3. Be sure the same day procedure does not have a 90-day global period. If so, it would be more appropriate to report modifier 57 to the E/M.

Are you unsure your billing practices are 100% accurate and you are getting paid for every claim? We offer FREE mini billing audits. Reach out today at contactus@elitecodingandbilling.com