Wiki Modifier 25 placement

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kgarcia1

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Hello everybody,
I am not an experienced coder and I need clarification on where to place the modifier 25. If a patient comes in for an E/M service and we do an additional service does the modifier go on the E/M visit or the addtional service (an EKG or an injection, etc.)? I thought it was on the addtional service but from other posts I've read it looks as though it is being placed on the e/m visit. Im confused! Obviously! I would appreciate any feedback. Thanks a bunch in advance.
 
Hi,

Modifier 25 only applies to an E/M service:

• That is above and beyond the procedure performed.
• That was provided on the same date as a diagnostic medical/surgical and/or therapeutic medical/surgical procedure(s).
• That is beyond the usual preoperative and postoperative care associated with the procedure.
• When a separate history was taken, a separate physical was performed and a separate medical decision was made and is documented in the medical record and -

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. As such a different diagnosis is not required, it may be reported by adding modifier 25 to the appropriate E/M Level.

But do not use this modifier to report an E/M service that resulted in a decision to perform surgery; see modifier 57!

Hope this helps you,

Thank You,

Purnima S, CPC
 
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