You'll be putting your practice in the crosshairs if you overuse 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: 2. Extent of Service Makes a Difference CPT's Appendix A states that 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." You need to add modifier 25 because minor procedures (0- and 10-day global procedures) include a small E/M within the value of the minor procedure. Therefore, in order to be paid for an E/M and the minor procedure, you have to tell the payer that the E/M was significant and separately identifiable from the minor procedure When the patient's complaint can stand alone as a billable service, you might be able to use modifier 25. How can you tell? "Look at the documentation and cross out anything that is directly related to the procedure performed," says Judith L. Blaszczyk RN, CPC, ACS-PM, compliance auditor with ACE consulting in Leawood, Kan. "Look then at the remaining documentation to determine if it is indeed significant, separately identifiable and medically necessary," she adds. Example: Pointer: 3. Global Period Length Offers Clues Another common point of confusion is between 25 and modifier 57 (Decision for surgery). You should only use modifier 25 with procedures that have a 0- or 10-day global period. These kinds of procedures are what Medicare defines as "minor." In contrast, you'll use modifier 57 for procedures with a 90-day global period. 4. Avoid Scrutiny, Don't Overuse 25 Some coders view modifier 25 as a "magic bullet," says Blaszczyk. She has heard from some coders that "always add a 25 modifier to their E/Ms done on the same day as a procedure because that is the only way they can get them paid," Blaszczyk adds. That kind of coding is improper and incorrect, says Palazzo. "Any practice that applies modifier 25 indiscriminately to their E/Ms will be an outlier to other practices in the volume of claims billed with modifier 25 and will be sending up red flags," says Blaszczyk.