General Surgery Coding Alert

Question: I’ve heard that we can use modifier 25 to bill two E/M visits on the same date of service. Is that true?

Nebraska Subscriber

Answer: That will be true, in some cases, effective Jan. 1, 2023. CPT^® updates to some E/M guidelines make that change. Prior to that time, you should reserve 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) for cases involving an E/M service on the same date as a procedure.

Update: Revised 2023 guidelines for initial nursing facility care state, “When the patient is admitted to the nursing facility in the course of an encounter in another site of service (eg, hospital emergency department, office), the services in the initial site may be separately reported. Modifier 25 may be added to the other evaluation and management service to indicate a significant, separately identifiable service by the same physician or other qualified health care professional was performed on the same date.”

The updated guidelines also include the following instruction: “When the patient is admitted to the hospital as an inpatient or to observation status in the course of an encounter in another site of service (eg, hospital emergency department, office, nursing facility), the services in the initial site may be separately reported. Modifier 25 may be added to the other evaluation and management service to indicate a significant, separately identifiable service by the same physician or other qualified health care professional was performed on the same date.”