. I have a patient that was seen with 99213 visit and 81001. Do I need to include modifier QW on 81001 if out lab is CLIA certified and do I need to append a 25 modifer to the office visit? Also I have sent a couple of claims to BCBS with an E/M visit along with 69209 for removal of impacted Cerumen and sent with right and left modifiers when bilateral. Both claims the ov and the 2nd 69209 is bundled? Should I be using a 50 modifier instead for bilateral and a 25 modifer on the office visit. I guess I am a little confused on when to use the 25 modifier. I have only been using it when we do an injection like depo for rocephin?? Thanks for your help. I am still new at coding and what to make sure I am sending things correctly.