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 sameday procedure, which means that the E/M prompted the subsequent 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 may be 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 surgeon would not make a decision for surgery based on a significant problem unrelated to the procedure.