Your modifier 25 claims should meet all of the following criteria:
Note that the diagnosis associated with the E/M service can be the same as the diagnosis associated with the same-day procedure, which means that the E/M prompted the follow-up procedure. Or, the diagnosis associated with the E/M service can be different than the diagnosis associated with the same-day procedure, meaning that the E/M was for a significant problem unrelated to the procedure.
Use modifier 57 if the claim meets all of the following criteria:
Because modifier 57 claims involve an E/M service that results in a decision for surgery, you would expect to see the same diagnosis code for both the E/M and the surgical procedure. The provider would not make a decision for surgery based on a significant problem unrelated to the procedure.