Health Information Management

Tip: Ensure record supports use of modifier -25

APCs Insider, April 15, 2011

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As part of the standard of care, a physician or nurse will record a patient's vital signs and examine the patient before performing a procedure. This work is considered part of the procedure. Coders should append modifier -25 only when the E/M service is ¬significantly above and beyond the norm or focuses on an area other than that where the procedure was performed.

When you have enough documentation for an E/M visit to stand on its own, bill the appropriate level of E/M service with modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). Ensure that the E/M visit with modifier -25 appended isn't the only item on the claim.

Also remember that modifier -25 appends to the E/M service even though its description is written as if it appends to the procedure code.

The tip is adapted from “Significant, separately identifiable E/M: Modifier -25” in the April issue of Briefings on APCs.



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