Corporate Compliance

Tip: Using modifier -25

Compliance Monitor, August 24, 2005

Use modifier -25 for a significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day as the procedure.

This modifier applies only to E/M service codes, and then only when an E/M service was provided on the same date as a diagnostic medical/surgical procedure.

  • Only use modifier -25 with E/M service codes, and then only for those within the range of 99202-92014, 99201-99499, and with healthcare common procedure coding system codes 60101 and 60175
  • Append modifier -25 to emergency department codes 99281-99285 when these services lead to a decision to perform diagnostic medical/surgical and/or therapeutic medical/surgical procedures
  • The diagnosis associated with the E/M service does not need to be different than the diagnosis for the diagnostic medical/surgical and/or therapeutic medical/surgical procedure(s)

    The above tip is an excerpt from the book "Modifier Training Handbook for Hospital Billers and Coders," Copyright 2004 by HCPro, Inc. This book is an easy-to-use training guide for billers, coders, and their HIM supervisors and managers that's written in plain English and takes the confusion out of the appropriate use of hospital modifiers.

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