Avoid modifier 25 scrutiny with proper 'separately identifiable' documentation. Reporting a separate E/M every time your surgeon performs a procedure is asking for an audit. Unlock the secrets to legitimate pay for separately identifiable E/M services using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) with these three guidelines. 1. Ensure Your General Surgeon Performed a Separate Service You should use modifier 25 when your surgeon's documentation supports that he performed an E/M service that was significant and separately identifiable from the work included in another service or procedure. Tip: Official guidance: Remember: Example: Because the hernia is a new problem, you can separately report the hemorrhoidectomy and the E/M service. You would code 46221 (Hemorrhoidectomy; internal, by rubber band ligation[s]) and the appropriate E/M code, such as 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) with modifier 25 appended. If that same patient had had only the hemorrhoid examination and no separate E/M service, then you would not bill a separate office visit code. Bottom line: 2. Don't Confuse Modifiers 25 and 57 The difference between 25 and modifier 57 (Decision for surgery) is a common point of confusion, because both involve your surgeon performing a procedure and distinct E/M service for the same patient on the same day. The quickest distinction is that you would use 25 for a distinct E/M with a minor procedure, and 57 for a distinct E/M with a major follow-up procedure. How it works: Watch out: 3. Stop Omitting 25 Because of Same Dx Proper modifier 25 use does not require a different diagnosis code. In fact, the presence of different diagnosis codes attached to the E/M and the procedure does not necessarily support a separately reportable E/M service. "The guidelines changed years ago that you do not need to have a different diagnosis to use modifier 25," says Jetton Torrix, CCS-P, CPC-H, course director of Knowledge Source Seminars in North Port, Fla. and Cross Country Education instructor. "But it still seems to be easier to get paid if the diagnoses are different," she adds. Go to the source: As such, different diagnoses are not required for reporting of the E/M services on the same date." How it works: Your doctor's documentation should clearly establish that the visit's purpose was not to perform the procedure. If your eceive denials on modifier 25 claims simply because you use the same diagnosis code for the E/M and the procedure, you should appeal assuming your surgeon's documentation supports reporting separate services.