AAPC - Back to school
Results 1 to 4 of 4

Thread: Mod 25 Necessary

  1. #1

    Default Mod 25 Necessary

    AAPC: Back to School
    Modifier 25 states: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.

    We all know that mod 25 is appended to the E&M or preventive code, but will it really make a difference for insurance payment if no modifier is appended and a procedure is performed with the E&M?

  2. #2
    Join Date
    Apr 2007
    North Carolina


    Yep...If it is a separate, identifiable E/M, chances are, the insurance company will deny the office visit as inclusive into the surgical procedure. This happens to us when the poster forgets to add this modifier.

  3. #3
    Join Date
    Apr 2007


    ditto to Rebecca!!

  4. #4

    Default mod -25

    I agree... the modifier should be appended when appropriate otherwise the reimbursement may be negatively impacted (item not paid). Modifier -25 applies to both facility and physician coding.

Similar Threads

  1. Mod 51 vs Mod 59 for ASC use
    By Tracy592 in forum Modifiers
    Replies: 3
    Last Post: 07-08-2015, 12:49 PM
  2. mod 62 denied can I use mod 80?
    By fisher.jaimie@gmail.com in forum Modifiers
    Replies: 6
    Last Post: 05-18-2015, 05:27 AM
  3. Mod 25
    By dpumford in forum Modifiers
    Replies: 2
    Last Post: 09-06-2011, 11:08 AM
  4. mod 25 - Can anyone shed some light on this
    By iovine in forum Billing/Reimbursement
    Replies: 4
    Last Post: 08-26-2011, 06:32 AM
  5. mod 25 & mod 59 with a 94664 (inhaler)
    By jsa1517 in forum Modifiers
    Replies: 2
    Last Post: 01-29-2010, 02:46 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.