News and Updates >> Client Update
April 20, 2009
Tips for Billing with Modifier 25
As you may know, Modifier 25 is used when 2 different services are billed on the same day. Modifier 25 is always attached to the E/M service only. It’s never appended to any procedures.
Here are some helpful tips.
1. Append a 25 modifier when an E/M service is performed on the same day of a procedure if applicable.
2. Consider using a modifier 25 for E/M services done on the same day as a procedure with a global period of 0 (zero), 10 or XXX.
3. When using a 25 modifier please make sure your documentation supports both services…E/M and procedure.
4. When appending a 25 modifier please link a different diagnosis to distinguish the E/M service from the procedure.
When NOT to use a 25 modifier
1. Do not use a 25 modifier when billing for services performed during a postoperative period if related to the previous surgery. These services are part of the global period.
2. Please do not append modifier 25 if there is only an E/M service performed during the office visit. Example: 99213 with no other procedures
3. Do not use a modifier 25 on any E/M on the same day a “Major” (90) day global procedure is being performed. It is, however, possible to use modifier 57- Decision for surgery.
4. NOTE: Modifier 24 (unrelated evaluation) should be used when seeing a patient during a postoperative period and the service is unrelated to the procedure (global period).
5. Do not append modifier 25 to an E/M service when a minimal procedure is performed on the same day unless the level of service can be supported. All procedures have “inherent” E/M service included.
If you have any questions regarding the use of a Modifier 25, please do not hesitate to contact your PhyLogic Billing Team Supervisor at 877-273-3100.