Understand 'significant' and 'separate' to move in the right direction. Starting point: 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 when deciding if your case meets the criteria: • Could the complaint or problem stand alone as a billable service? A single trigger point injection (20552, Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]), for example, qualifies as a stand-alone service you might see in conjunction with an E/M visit. • Do you have a different diagnosis for the portion of the visit unrelated to the initial service? For example, the patient might be in the office for a planned knee injection, but also complains of shoulder pain during the visit. Reporting an E/M code with modifier 25 would be appropriate for the services performed and documented concerning the shoulder. If you can answer "yes" to either question, you're one step closer to reporting modifier 25. Example: 2. Check for Additional Work If the diagnosis remains the same, Quita Edwards, CCS-P, CPC, COSC, CPC-I, owner of CASE Contracting Services in Fort Valley, Ga., says you have a third question to ask: Did your orthopedist perform extra work that went above and beyond the typical pre- or postoperative work associated with the procedure code? Another affirmative answer points you to modifier 25. Example: Even though the diagnosis you report for the injection and the E/M service will be the same, you can separately report the two services in this case. "The physician spent enough time discussing the surgery to count as significant and separately identifiable from the injection," Edwards explains. "You can bill an E/M code with modifier 25 based on the amount of time he spent, even though he didn't evaluate the patient." 3. Look for Pre-Planning Modifier 25 is meant for those "oh, by the way" type situations, not procedures that are tied to previous services. Consider these scenarios and whether you think they merit modifier 25, then tune in next month for our experts' recommendations. Scenario 1: Scenario 2: Scenario 3: