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Family Practice Coding Alert

Reader Question:

Verify All Services, E/M Care for Modifier 25

Question: I don't think our office is using modifier 25 correctly. Does this get used even when we complete a simple office lab, such as a throat culture or urine dip? I'm asking because one of our coders uses modifier 25 when we give a flu shot. Should we use it with every additional thing we do during a visit? Connecticut Subscriber Answer: The first rule to remember for modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is that you can only append it to E/M codes. Modifier 25 applies when the physician conducts another service during the encounter in addition to the E/M service. Verify that you have adequate documentation explaining both services, however, before reporting modifier 25. Typically, you only need to append modifier 25 to an E/M code when reporting other codes on the same [...]

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