Modifier 25

Modifier 25 is appended with distinctly recognizable Evaluation and Management service, which is significant and provided on the same day as the other procedure or Evaluation and Management service by the same provider or other certified professional.

Modifier 25 should always be appended with E/M services and not be appended with non E/M service which is significant and separately identifiable.

Important Note:

1. Modifiers 24, Modifier 25 and Modifier 57 are appended to E/M codes to report payable services within the global package.
2. Modifier 25 is used to report an E/M Service that is not resulted in a decision to perform surgery.

Example:

When ongoing E/M services on the day, the procedural related to thrombolysis performed. We should not report E/M service, because the E/M services are included in thrombolysis services (37211-37214). Only if the other or separately identified E/M services performed by the same physician on the same day the thrombolysis procedure performed, then we need to report an appropriate E/M service and append modifier 25.

3. As per the coding guidelines for E/M services 92002 to 92014 we should add modifier 25, when we will bill with special ophthalmological services.

Example: 92002 with modifier 25, 92015

4. Append modifier 25 to an E/M service, when the patient reason for visit is hypertension and on the same session asks the physician to perform a biopsy of a soft tissue of neck.

In this example the services are unrelated, so we need to report the E/M service by appending modifier 25 as follows:

21550 and 99203 with modifier 25

 

Usage of modifier 25 with examples:

Example 1:

A Medicare patient is seen in the Emergency department after a fall. After examination, the patient was found to have a 2 cm laceration of the thigh and a 0.5 cm laceration of the wrist. The thigh was repaired with sutures, and the wrist was repaired with derma bond.

Here the patient is seen by an emergency department physician after a fall and the laceration repair of the thigh and wrist performed. So in this case E/M code with modifier 25, the laceration repair codes and the wound closure utilizing tissue adhesive only would be billed.

99281 with modifier 25, 12001, G0168 with modifier 59

 

Example 2:

A 61 year old woman presented to the eye clinic as a new patient with symptoms of flashing lights and floaters in the right eye for two days. The ophthalmologist physician does an overall assessment of the complete visual system, including dilating her eyes and testing her with an indirect ophthalmoscope, revealing peripheral retinal tears. The provider describes to the patient that there is a probability of retinal detachment. The patient agrees to have the procedure. The ophthalmologist physician lasers the retinal tear and states the patient to return back within 24 hours for follow up.

In this example we report the surgery code and E/M ophthalmology service code with modifier 25 as follows:

67145 and 92004 with modifier 25

 

Example 3:

An established patient Annie visits the doctor office, after the ophthalmologist physician does a comprehensive exam patient has been identified with dry eye syndrome in her both eyes. The ophthalmologist physician measures the cornea for placement of the soft contact lens for treatment of this syndrome.

Here we report the special ophthalmology services code and E/M ophthalmology service with modifier 25 as follows:

92014 with modifier 25 and 92072