I am going back and forth with this example to decide is modifier 25 is appropriate. Podiatrist is requested (consult) to see a new patient in the nursing home for mycotic nails. The podiatrist performs a 11721 (debridement of 6 or more nails) on patient. The podiatrist only bills out the initial 99304 visit. I know that an E&M code is part of the pre&post surgery code. I am trying to figue out if a modifier 25 (seprate above and beyond warrants this example)? I ask myself "did the podiatrist know that they were going to perform debridement automatically", I don't know and can't assume a yes or no answer to this. I have read the Medicare guidelines that it doesn't matter if a patient is new or established regarding the pre & postoperative care associated with the procedure or service that was performed. Any advise or opinions would be greatly appreciated to ease this confusion of a gray area I am having.