Hello dovejsd, I would direct you to some of the best guidance that I can find through the American Academy of Family Practice website - www.aafp.org and put in a search for "modifier 25".
This is a difficult but easy modifier to use. You have to be able to justify each service billed for. In the case of a patient coming in for ear pain/cerumen impaction: Doc does normal workup for ear pain and through the course of examination discovers a cerumen impaction which is curetted and irrigated clear. This service now qualifies for only code 69210 - BUT - an otitis media is now diagnosed. A workup and treatment plan is now completed for this ailment (in this case, prob only enough for a level 2 visit; established). While these conditions sort of "overlap" one another, they are different and require different treatments to resolve. A modifier 25 would apply here.
Hope this helps
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