Usage of Modifier 25

Most used Modifier 25

- is Significant, Separately Identifiable Evaluation andManagement Service by the Same Physician on the Same Day of theProcedure or Other Service.

Key Points to Remember:

When using this modifier, Medical Documentation is vital and essential to support medical necessity. This must be well-documented on the patient's medical record.

You are using Modifier -25 because you are stating that the Evaluation and Management Service is separate from that of the procedure performed on the same day.

Append this modifier if and only if it is a medical necessity and is a separately identifiable E/M service of that with the procedure done on the same day.

Sample Encounter 1:

The patient came in to the office with a chief complaint of entire body ache. She also present with an abscessed toe nail which she claims started after she cut her toe nails using a toe-nail cutter 2 days ago. The physician then added the incision and drainage procedure performed on the abscessed toe nail.

Codes:

99212-25

18060

Sample Encounter 2:

The patient came in to the office for her scheduled 2nd therapeutic knee injection. On the same day, she presented herself as complaining with neck pain that has been bothering her sleep for the past 3 days. The physician then added a separate E/M service.

Codes:

99213-25

20610



CPT code Modifiers
CPT modifier
CPT modifiers
ASC modifier SG
CPT modifier 51
CPT modifier 62 and 66
CPT Modifier 22 and 51
CPT modifier 22 and 24
CPT modifier 52 and 53
CPT modifier 26 and TC
CPT modifier 59
CPT anesthesia modifier codes
ASC modifiers
Modifier 59
CPT modifier 25
CPT modifier 24
CPT modifier 57
CPT modifier 78
CPT Modifier 79
Surgical modifiers
CPT modifier 58
CPT billing codes
CPT codes and HCPCS codes
What is Medical coding

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