Cardiology Coding Alert

Question: I’m new to coding, and I am struggling with some of the modifier rules. When can I append modifier 25 to a CPT^® code?

California Subscriber

Answer: Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) is one that people often misuse.

Heed the following rules to help you properly append modifier 25 in your practice:

• Rule 1: You can only append modifier 25 to evaluation and management (E/M) service codes 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components ...) through 99499 (Unlisted evaluation and management service).
• Rule 2: You may use modifier 25 only when your provider’s documentation proves that he performed a medically necessary and “significant, separately identifiable” E/M service in addition to the original procedure. Your physician must include a separate History, Examination, and Medical-decision making (HEM) for the E/M service in his documentation.
• Rule 3: The E/M service must occur on the same calendar day as the original procedure for the same patient.
• Rule 4: The procedure following the E/M would be a minor procedure, meaning that it has a zero or 10-day global period.