Modifier code
Modifier 25: Significant, separately identifiable E&M service on same day as procedure
When E&M visit + procedure happen same day and the E&M was separately documented from the procedure.
Code
25
When to use
Patient presents for one thing, a separately identifiable problem is addressed, AND a procedure is done. Documentation must clearly support the separate E&M.
Common issues
- E&M denied as bundled when modifier 25 not appended
- Insurer requesting documentation review to validate
Frequently asked questions
What is modifier 25?
Significant, separately identifiable E&M service on same day as procedure
When should it be used?
Patient presents for one thing, a separately identifiable problem is addressed, AND a procedure is done. Documentation must clearly support the separate E&M.
Common issues when modifier is missing or wrong?
E&M denied as bundled when modifier 25 not appended; Insurer requesting documentation review to validate.
Other modifiers
- 26 — Professional componentSplits a procedure into its professional (physician interpretation) and technica
- 50 — Bilateral procedureProcedure performed on both sides of the body during a single session.
- 51 — Multiple proceduresMultiple procedures performed at the same session.
- 52 — Reduced servicesService partially reduced or eliminated at the physician's discretion.
- 53 — Discontinued procedureProcedure discontinued because of extenuating circumstances.
- 57 — Decision for surgeryE&M visit at which decision for major surgery was made.
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