California Medical Association: Separately Billing in E/M Visits

An evaluation and management (E/M) service may be separately billed with a minor procedure as long as the E/M service was clearly documented and substantiated, and as long as modifier 25 is properly appended to the appropriate E/M service code. G. John Verhovshek, MA, CPC, recently authored an article for the California Medical Association’s Practice Resources, in which he explained the guidelines and instructions to properly using modifier 25.

“The question persists,” he wrote, “How do you decide if an E/M service is truly ‘significant’ and ‘separately identifiable’ (and separately reportable with modifier 25)?” His answer is to ask yourself if you can “pick out from the documentation a clear history, exam and medical decision-making process apart from any other procedures the physician performs on the same day. If so, you’ve probably got a billable service with modifier 25.”

Evaluation and Management – CEMC

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