Orthopedic Coding Alert

Understand 'significant' and 'separate' to move in the right direction. Knowing when to report modifiers and choosing the best one for each situation can be an easy trip-up for coders. If you find yourself especially befuddled by modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), keep reading for real-world tips that will help you code confidently every time. Starting point: Remember you can only consider reporting modifier 25 when coding an E/M service. If the procedures you're reporting don't fall under E/M services, check whether the encounter qualifies for modifier 59 (Distinct procedural service) instead. 1. Verify That Service Is Significant As CPT's Appendix A explains, a significant and separately identifiable service "is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported." Ask yourself two questions [...]