Wiki Modifier 25

[nturner1]

If a provider see a patient in the clinic and removes an actinic keratoses during the visit, then recommend the patient to return in 3 months for a follow up exam. On the follow up visit, the patient has another actinic keratoses that is removed. Does this support a modifier 25 to bill procedure and the E/M visit? Or does this support a planned procedure?

 

[jkyles]

Hi there, the only way to be certain is to check the documentation to see whether the doctor performed an E/M visit that meets the definition for modifier 25.

Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service. It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service). The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service. Note: This modifier is not used to report an E/M service that resulted in a decision to perform surgery. See modifier 57. For significant, separately identifiable non-E/M services, see modifier 59.

 

[nturner1]

Thank you!