BC Advantage - 2024 Issue 7

Understanding and Correctly Reporting CPT Modifier 25

Modifiers in medical coding serve to indicate specific circumstances that alter the usual definition of a service or procedure, often in response to payment policy requirements established by various entities. Detailed definitions of these modifiers can be found in Appendix A of the Current Procedural Terminology (CPT®) 2023 code set.   Modifier 25 Overview   Modifier 25, "Significant, separately identifiable Evaluation and Management (E/M) service by the same physician or other Qualified Healthcare Professional (QHP) on the same day of the procedure or other service," is crucial for indicating distinct services performed on the same day. While...

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