Medicare Compliance & Reimbursement

You'll be putting your practice in the crosshairs if you misuse this modifier. Knowing when to append a modifier can be tricky, but many coders will tell you that one of the most misunderstood is modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). If you count yourself in that confused group, use these four criteria to determine whether modifier 25 is right for your next coding assignment. 1. Modifier 25 is for E/M Only You can only consider reporting modifier 25 when coding an E/M service, says Janet Palazzo, CPC, of Regional Otolaryngology in Cherry Hill, N.J. If the procedures you're reporting don't fall under E/M services, it's possible the encounter qualifies for another modifier instead. How it works: You would use modifier 25 to indicate you have documentation that supports an E/M was significant [...]