tci Part B Insider - 2010 Issue 27

Three Conditions Warrant Modifier 25

There are three basic conditions under which an E/Mservice might qualify for a 25 modifier:1. You have a different diagnosis for the E/M and the procedure. The two diagnoses may be related -- such as when the diagnosis with the E/M is a sign or symptom and the diagnosis with the procedure more definitive. In this case, the E/M resulted in a decision to perform the procedure, either diagnostic or therapeutic. 2. The second condition is similar, except on doing the  procedure, there is no second diagnosis. Medicare specifically states that there is no requirement forseparate and distinct diagnoses...

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