Modifier 25, Significant, separately identifiable evaluation and management service by the same
physician on the same day of the procedure or other service:

This modifier must be appended with an E/M service. This is the modifier you will need to use with the
evaluation and management service done on the same day with other procedure done by the same
physician. It has to be above and beyond the usual preoperative and postoperative encounter with the
procedure. In fact, by using this modifier, it doesn't have to have a different diagnosis reported. The most
important thing is that, the E/M level should meet its key components
or if it is selected based on time
spent with the patient (counseling and coordination of care). You have to be careful in using this modifier.
It must meet medical necessity. As you know, there are procedures that already includes all other
coordination of care and management.

Let's describe this modifier 25:

A patient came in for her monthly follow up for her chronic back pain. At the same time, patient was
complaining with severe headache. The pain doctor performed bilateral occipital block on the patient at
the time of service. You will append modifier 25 for the E/M code to indicate that both services were
rendered on the same day.

You don't use modifier 25 with E/M encounter that resulted to Decision for Surgery (we have another
modifier for this!)

Sample Encounter 2:

The patient came in to the office for her scheduled 2nd therapeutic knee injection. On the same day, she
presented herself as complaining with neck pain that has been bothering her sleep for the past 3 days.
The physician then added a separate E/M service.

Codes:       99213-25

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How to Use Modifier

What is Modifier -25
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