Question: California Subscriber Answer: Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99213 to indicate that your urologist performed a separate E/M service. Example: A patient comes to your office for a routine follow-up cystoscopy, and after the procedure the urologist reviews the results of the examination with the patient indicating that he found a recurrent bladder tumor. The urologist counsels the patient and coordinates his care, discussing transurethral resection of bladder tumor (TURB) and necessary further work up. For this scenario, you should bill for the cystoscopy and also for an E/M service with modifier 25. Select the E/M level based on the amount of time the physician spent counseling the patient and coordinating his care. Example 2: This is a new problem, and the urologist should document this in the medical record as a separate and new diagnosis. In this case, you should bill 52000 and also an office visit code separately with modifier 25 attached because different diagnoses will support separate services. If that same patient had had only the cystoscopic examination and no separate E/M service, then you would not bill a separate office visit code. Bottom line: -- Answers to