tci E/M Coding Alert - 2023 Issue Q2

Reader Questions: Remember This Quick Advice on Modifier 25 Usage

Question: We worry about using modifier 25 incorrectly. Can you explain key considerations and provide tips on proper application? Missouri Subscriber Answer: Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician … on the same day of the procedure or other service) applies when a provider performs an evaluation and management (E/M) service on the same day as a minor procedure or service. Before appending modifier 25 to the E/M code, make sure the E/M service is significant, the documentation substantiates this, and the physician’s work is medically necessary. Here’s a summary of...

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