Primary Care Coding Alert

The answer to your question gives 'yes' or 'no' to modifier 25.If your family physician performs an E/M service and a procedure on the same patient during the same encounter, you might be able to report the E/M using modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). Or you might not.The key: You must prove that the E/M is a separate service and is not a built-in component of the procedure. Remember two things to determine when to report an E/M with modifier 25, and when to leave the E/M off the claim.Uncover E/M Evidence in Notes"Coders should use modifier 25 when a significant, separately identifiable E/M service is performed by the same physician at the same face-to-face encounter as a procedure or other service," says Catherine Brink, CMM, CPC, president of Healthcare Resource Management of Spring [...]