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Modifier 25

Simone Posted Wed 18th of August, 2010 21:38:46 PM

I thought I read some guidelines stating that Modifier 25 is not used on New Office Patient Visits (99201-99205), am I correct?


SuperCoder Answered Thu 19th of August, 2010 04:39:52 AM

It's not exactly like that. Modifier 25 can be used only when a significant, separately identifiable E/M service is performed by the same physician on the same day of providing a surgical procedure. And usually that Sx is a minor one (with a global period of 10 days). So if you find a scenario, where a minor Sx is performed and on the same day another E/M service (significant, separately identifiable) is provided by the same doctor, and most importantly, if the documentation supports significance & necessity of that separate E/M service (above and beyond the scope of the Sx performed), then definitely you can code a new office visit code (99201 - 99205), if the patient is, of course, New. This is applicable provided you are following the CPT's NEW vs. ESTABLISHED Pt. rule.

Sherry Answered Tue 24th of August, 2010 10:17:08 AM

The modifier used for when a doctor does a procedure in his office on the same day as he is being seen for maybe the sniffles and an impaction in pts ear is found and a cerumum removal is needed. In this case you would code the office visit with a 25 and the removal of ear wax, because the pts original complaint was not one of ear pain etc. But if a surgery is performed you would use the modifier 57 "decision for surgery". I hope I haven't confused anybody!

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