Modifier 25

Reviewers have noted that often documentation did not reflect a distinct, separate
evaluation and management (E/M) service performed on the same day as a
procedure.

Modifier 25 is defined as a significant, separately identifiable E/M service by the
same physician on the same day of the procedure or other service.

The patient’s medical record documentation is expected to clearly show that the
E/M service was “above and beyond” the usual pre-operative and post-operative
care associated with the procedure performed on the same day.

Inappropriate use of modifier 25 could increase the appearance of high utilization
and could warrant more intense reviews into providers billing patterns and more
Progressive Corrective Action Probes.

Please note: if a significant separately identifiable service occurs during a post-
procedure global coverage period, but not on the same day as the procedure, use
modifier 24.

Modifier 25 is not needed if an E/M patient encounter occurred the day before minor
surgery was performed, since the global period for minor procedures (000 days)
does not include the day prior to surgery.