Medicare Compliance & Reimbursement

Take our quick quiz to determine whether you're appending modifier 25 appropriately. Your patient may require a service and an E/M visit on the same date, but if you aren't applying modifier 25 properly, you might have to kiss reimbursement goodbye. Starting point: Remember that you can only consider reporting modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) when coding an E/M service with a procedure. If your physician performs two procedures, neither of which is an E/M service, check whether the encounter qualifies for modifier 59 (Distinct procedural service) instead. Do not add a modifier 25 just because the procedure was not scheduled prior to the visit. If the E/M service your physician performed is only the minor E/M associated with the procedure, you cannot add modifier 25. As CPT's Appendix A explains, a [...]